Provider Demographics
NPI:1790981504
Name:SCHULZ, AMBER LYNN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:LYNN
Last Name:SCHULZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 S 167TH CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118-2626
Mailing Address - Country:US
Mailing Address - Phone:402-933-6258
Mailing Address - Fax:
Practice Address - Street 1:152 S 167TH CIR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-2626
Practice Address - Country:US
Practice Address - Phone:402-933-5268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE634314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility