Provider Demographics
NPI:1134952625
Name:SCHULZE, SAMUEL WALTER (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:WALTER
Last Name:SCHULZE
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9845 ERMA RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1057
Mailing Address - Country:US
Mailing Address - Phone:616-402-3028
Mailing Address - Fax:
Practice Address - Street 1:9845 ERMA RD STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1057
Practice Address - Country:US
Practice Address - Phone:616-402-3028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14207560-4405363LP0808X
AZ350578363LP0808X
CA95031692363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health