Basic Information
| Provider Information | |||||||||
| NPI: | 1861687170 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHULTZ | ||||||||
| FirstName: | KANDICE | ||||||||
| MiddleName: | DIANNE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | RN, ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 104 CRESTWOOD DR SW | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984983832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093660361 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9040 REID ST | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984311100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539682252 | ||||||||
| FaxNumber: | 2539683278 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2007 | ||||||||
| LastUpdateDate: | 01/30/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | RN-0016525 | WA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 363LF0000X | RN 00165285 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.