Basic Information
| Provider Information | |||||||||
| NPI: | 1619911559 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHULTZ | ||||||||
| FirstName: | CRAIG | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 NE KNOTT ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972123014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032533910 | ||||||||
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| Practice Location | |||||||||
| Address1: | 301 NE KNOTT ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972123014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032533910 | ||||||||
| FaxNumber: | 5032534297 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 05/14/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 099007734RN | OR | N | Allopathic & Osteopathic Physicians | Dermatology | 363L00000X | AP30005962 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | 200150081NP | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.