Provider Demographics
NPI:1962409490
Name:SCHULTZ, JEFFREY DALE (CRNA)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:DALE
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 6TH AVE NE
Mailing Address - Street 2:APT 11
Mailing Address - City:VALLEY CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58072-2364
Mailing Address - Country:US
Mailing Address - Phone:710-845-0715
Mailing Address - Fax:
Practice Address - Street 1:570 CHAUTAUQUA BLVD
Practice Address - Street 2:
Practice Address - City:VALLEY CITY
Practice Address - State:ND
Practice Address - Zip Code:58072-3145
Practice Address - Country:US
Practice Address - Phone:701-845-6400
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR31111367500000X
SDR022879367500000X
MNR136952-0367500000X
TX647231367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered