Provider Demographics
NPI:1659482180
Name:SCHULTZ, SARAH MARIE (RN, CFNP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MARIE
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:RN, CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N4510 COUNTY ROAD Y
Mailing Address - Street 2:
Mailing Address - City:CHILTON
Mailing Address - State:WI
Mailing Address - Zip Code:53014-9345
Mailing Address - Country:US
Mailing Address - Phone:651-334-9369
Mailing Address - Fax:
Practice Address - Street 1:618 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:CHILTON
Practice Address - State:WI
Practice Address - Zip Code:53014-1568
Practice Address - Country:US
Practice Address - Phone:920-849-3823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR158431-8363L00000X
CANP 23482363LF0000X
WI6645-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNQ75164Medicare UPIN
MN500003704Medicare PIN