Basic Information
| Provider Information | |||||||||
| NPI: | 1902258502 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHULTZ | ||||||||
| FirstName: | KARISSA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | APRN, CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | ESSENTIA HEALTH DULUTH CLINIC MSS 6AV1-PE | ||||||||
| Address2: | 400 EAST THIRD STREET | ||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558051951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187861183 | ||||||||
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| Practice Location | |||||||||
| Address1: | 115 10TH AVENUE NE SUITE A | ||||||||
| Address2: | ESSENTIA HEALTH DEER RIVER CLINIC | ||||||||
| City: | DEER RIVER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 566368795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2182468275 | ||||||||
| FaxNumber: | 2182468279 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2016 | ||||||||
| LastUpdateDate: | 04/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 2366124 | MN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LP2300X | R37224 | ND | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 363LA2200X | 4700 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363L00000X | R37224 | ND | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.