Provider Demographics
NPI:1861687170
Name:SCHULTZ, KANDICE DIANNE (RN, ARNP)
Entity Type:Individual
Prefix:MS
First Name:KANDICE
Middle Name:DIANNE
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:RN, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:104 CRESTWOOD DR SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-3832
Mailing Address - Country:US
Mailing Address - Phone:509-366-0361
Mailing Address - Fax:
Practice Address - Street 1:9040 REID ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-1100
Practice Address - Country:US
Practice Address - Phone:253-968-2252
Practice Address - Fax:253-968-3278
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN-0016525390200000X
WARN 00165285363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program