Provider Demographics
NPI:1366468712
Name:SCHULZ, HEIDI (PA)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:SCHULZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 GRAVELY BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-8438
Mailing Address - Country:US
Mailing Address - Phone:828-552-5515
Mailing Address - Fax:
Practice Address - Street 1:270 GRAVELY BRANCH RD
Practice Address - Street 2:
Practice Address - City:FLETCHER
Practice Address - State:NC
Practice Address - Zip Code:28732-8438
Practice Address - Country:US
Practice Address - Phone:828-552-5515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00025100363A00000X
NC0010-02784202D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ004827Medicare ID - Type Unspecified
NJS47845Medicare UPIN