Provider Demographics
NPI:1497738124
Name:SCHULTZ, GARY JAMES (RN)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:JAMES
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S11441 SELL RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:WI
Mailing Address - Zip Code:54722-7427
Mailing Address - Country:US
Mailing Address - Phone:715-286-4508
Mailing Address - Fax:
Practice Address - Street 1:S11441 SELL RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:WI
Practice Address - Zip Code:54722-7427
Practice Address - Country:US
Practice Address - Phone:715-286-4508
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38312200Medicaid