Provider Demographics
NPI:1164262226
Name:SCHULTZ, AMANDA MARIE (OMD, L AC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:OMD, L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 RAYBURN DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-3205
Mailing Address - Country:US
Mailing Address - Phone:016-612-0061
Mailing Address - Fax:
Practice Address - Street 1:10471 DOUBLE R BLVD STE D
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-8946
Practice Address - Country:US
Practice Address - Phone:775-277-3655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2503171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist