Basic Information
| Provider Information | |||||||||
| NPI: | 1548525769 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHULTZ | ||||||||
| FirstName: | WANDA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4835 WEBSTER RD | ||||||||
| Address2: | |||||||||
| City: | FREDONIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140639628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7165980695 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1680 WALDEN AVE | ||||||||
| Address2: | |||||||||
| City: | CHEEKTOWAGA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142254914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168947777 | ||||||||
| FaxNumber: | 7168940607 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2012 | ||||||||
| LastUpdateDate: | 07/13/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 291419 | NY | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.