Provider Demographics
NPI:1922427640
Name:SCHULTZ, DONNA J (FNP-C)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:J
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3126 S JACKSON AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-2534
Mailing Address - Country:US
Mailing Address - Phone:417-781-4727
Mailing Address - Fax:417-627-8727
Practice Address - Street 1:3126 S JACKSON AVE
Practice Address - Street 2:STE 201
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-2534
Practice Address - Country:US
Practice Address - Phone:417-781-4727
Practice Address - Fax:417-627-8727
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2014003273363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200560000AMedicaid
MO1922427640Medicaid
KS201094210AMedicaid
MO1922427640Medicaid
MOMA3446252Medicare PIN