Provider Demographics
NPI:1902172372
Name:SCHUTZENHOFER, KARLA ANNE (APN)
Entity Type:Individual
Prefix:MRS
First Name:KARLA
Middle Name:ANNE
Last Name:SCHUTZENHOFER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1054 MARTIN LUTHER KING DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801-3000
Mailing Address - Country:US
Mailing Address - Phone:618-545-1705
Mailing Address - Fax:618-545-1703
Practice Address - Street 1:1054 MARTIN LUTHER KING DR
Practice Address - Street 2:SUITE 220
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-3000
Practice Address - Country:US
Practice Address - Phone:618-545-1705
Practice Address - Fax:618-545-1703
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209009461363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health