Provider Demographics
NPI:1851470389
Name:SCHULTZ, NANCY LEE (LPN)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LEE
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:LEE
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11460 REHM RD
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NY
Mailing Address - Zip Code:13316-5423
Mailing Address - Country:US
Mailing Address - Phone:315-245-4383
Mailing Address - Fax:
Practice Address - Street 1:11460 REHM RD
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NY
Practice Address - Zip Code:13316-5423
Practice Address - Country:US
Practice Address - Phone:315-245-4383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00230429164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01790243Medicaid