Provider Demographics
NPI:1770110298
Name:SCHULTZ, GREGORY ALEXANDER (NP)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:ALEXANDER
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W362S4702 STEWART CT
Mailing Address - Street 2:
Mailing Address - City:DOUSMAN
Mailing Address - State:WI
Mailing Address - Zip Code:53118-9523
Mailing Address - Country:US
Mailing Address - Phone:262-965-3339
Mailing Address - Fax:
Practice Address - Street 1:236 LEPHILLIP COURT
Practice Address - Street 2:SUIRE E
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025
Practice Address - Country:US
Practice Address - Phone:704-721-0359
Practice Address - Fax:704-721-0439
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9046-33363LA2100X
NC5011671363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care