Provider Demographics
NPI:1699929760
Name:SCHANTZ, MARTHA K (PA-C)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:K
Last Name:SCHANTZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6615 DELMONICO DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-1809
Mailing Address - Country:US
Mailing Address - Phone:719-364-9494
Mailing Address - Fax:719-364-9761
Practice Address - Street 1:6615 DELMONICO DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-1809
Practice Address - Country:US
Practice Address - Phone:719-364-9494
Practice Address - Fax:719-364-9761
Is Sole Proprietor?:No
Enumeration Date:2008-11-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0004082363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant