Provider Demographics
NPI:1316314511
Name:SCHULTZ, BRANDY N
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:N
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MADILL
Mailing Address - State:OK
Mailing Address - Zip Code:73446-3807
Mailing Address - Country:US
Mailing Address - Phone:580-795-3794
Mailing Address - Fax:580-795-3170
Practice Address - Street 1:605 S 1ST ST
Practice Address - Street 2:
Practice Address - City:MADILL
Practice Address - State:OK
Practice Address - Zip Code:73446-3807
Practice Address - Country:US
Practice Address - Phone:580-795-3794
Practice Address - Fax:580-795-3170
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health