Provider Demographics
NPI:1699825430
Name:SCHULZ, BERTHA (CRNP)
Entity Type:Individual
Prefix:
First Name:BERTHA
Middle Name:
Last Name:SCHULZ
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 FALLSWAY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-4800
Mailing Address - Country:US
Mailing Address - Phone:443-703-1321
Mailing Address - Fax:
Practice Address - Street 1:421 FALLSWAY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-4800
Practice Address - Country:US
Practice Address - Phone:443-703-1321
Practice Address - Fax:443-703-1494
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR040674363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner