Provider Demographics
NPI:1366593220
Name:SCHULTZ, MICHELLE RENAE (RD,LDN)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:RENAE
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:RD,LDN
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1005 HEALTH CENTER DR STE 201
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-4693
Mailing Address - Country:US
Mailing Address - Phone:217-238-6055
Mailing Address - Fax:
Practice Address - Street 1:1004 HEALTH CENTER DR STE 110
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-4607
Practice Address - Country:US
Practice Address - Phone:217-238-3488
Practice Address - Fax:217-238-3485
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.003540133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered