Provider Demographics
NPI:1194181040
Name:SCHULDT, SAMANTHA (FNP-C)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:SCHULDT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:SCHEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:233 E SUPERIOR ST FL 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2913
Mailing Address - Country:US
Mailing Address - Phone:312-472-1234
Mailing Address - Fax:312-472-6300
Practice Address - Street 1:233 E SUPERIOR ST FL 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2913
Practice Address - Country:US
Practice Address - Phone:312-472-1234
Practice Address - Fax:312-472-6300
Is Sole Proprietor?:No
Enumeration Date:2016-01-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013543363L00000X
NY340232363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1194181040Medicaid