Provider Demographics
NPI:1013496777
Name:SCHULLER, MICHELLE M (RN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:SCHULLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 SW NYE ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-3821
Mailing Address - Country:US
Mailing Address - Phone:541-265-4179
Mailing Address - Fax:541-265-4194
Practice Address - Street 1:4422 NE DEVILS LAKE BLVD STE 2
Practice Address - Street 2:
Practice Address - City:LINCOLN CITY
Practice Address - State:OR
Practice Address - Zip Code:97367-5000
Practice Address - Country:US
Practice Address - Phone:541-265-4947
Practice Address - Fax:541-994-0261
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201407564RN163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health