Provider Demographics
NPI:1336550698
Name:SCHULTZ, KATHLEEN (CRNA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 W IRONWOOD DR
Mailing Address - Street 2:STE D #287
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-1403
Mailing Address - Country:US
Mailing Address - Phone:208-765-8585
Mailing Address - Fax:
Practice Address - Street 1:2204 IRONWOOD PL
Practice Address - Street 2:STE B
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2662
Practice Address - Country:US
Practice Address - Phone:208-765-8585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRNA-535A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered