Provider Demographics
NPI:1649267808
Name:SHULTZ, JOANNE C (CRNP)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:C
Last Name:SHULTZ
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
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Mailing Address - Street 1:2134 SANDY DR STE 16
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-2292
Mailing Address - Country:US
Mailing Address - Phone:814-272-5805
Mailing Address - Fax:814-272-0110
Practice Address - Street 1:2134 SANDY DR STE 16
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-2292
Practice Address - Country:US
Practice Address - Phone:814-272-5805
Practice Address - Fax:814-272-0110
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2019-10-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAUP004244-B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50017752OtherCAPITAL BC/BS
PA340344OtherHIGHMARK BS
PA500030393OtherRAILROAD MEDICARE
PAS76550Medicare UPIN
PA025840QV2Medicare PIN