Provider Demographics
NPI:1770551178
Name:SCHULTZ-CZARNIAK, JACLYN M (NNP)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:M
Last Name:SCHULTZ-CZARNIAK
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:M
Other - Last Name:SCHULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NNP
Mailing Address - Street 1:349 COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-5581
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:349 COUNTRY RD
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-5581
Practice Address - Country:US
Practice Address - Phone:651-439-9411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1689-33363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP74660Medicare UPIN