Provider Demographics
NPI:1457596348
Name:SCHANTZ, MARY JANE (RN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JANE
Last Name:SCHANTZ
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 1:1230 RICHMAN RD
Mailing Address - Street 2:
Mailing Address - City:KIMBALL
Mailing Address - State:MI
Mailing Address - Zip Code:48074-2816
Mailing Address - Country:US
Mailing Address - Phone:810-367-6365
Mailing Address - Fax:
Practice Address - Street 1:32743 23 MILE RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-1985
Practice Address - Country:US
Practice Address - Phone:586-725-3322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704260293163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse