Provider Demographics
NPI:1477715365
Name:SCHULTZ, CONNIE RAE (MS)
Entity type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:RAE
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:CONNIE
Other - Middle Name:RAE
Other - Last Name:BUECHEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:700 S PARK ST
Mailing Address - Street 2:GENETICS / MATERNAL FETAL MEDICINE
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1830
Mailing Address - Country:US
Mailing Address - Phone:608-258-5699
Mailing Address - Fax:608-258-6772
Practice Address - Street 1:700 S PARK ST
Practice Address - Street 2:GENETICS / MATERNAL FETAL MEDICINE
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1830
Practice Address - Country:US
Practice Address - Phone:608-258-5699
Practice Address - Fax:608-258-6772
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI96215170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS