Provider Demographics
NPI:1285609149
Name:SCHULTZ, PATRICIA M (NP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:M
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1650 W HARRISON ST
Mailing Address - Street 2:ATRIUM 430
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3800
Mailing Address - Country:US
Mailing Address - Phone:312-942-5800
Mailing Address - Fax:312-942-5919
Practice Address - Street 1:1650 W HARRISON ST
Practice Address - Street 2:ATRIUM 430
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3800
Practice Address - Country:US
Practice Address - Phone:312-942-5800
Practice Address - Fax:312-942-5919
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209002885163WG0000X
IL209-002885363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209002885OtherLICENSE