Individual
STEFANIE ALIDA SCHULTIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
110 LAKEVIEW DR, SUITE 100, COVINGTON, LA 70433-7509
(985) 898-1940
(985) 893-3427
Mailing address
110 LAKEVIEW DR, SUITE 100, COVINGTON, LA 70433-7509
(985) 898-1940
(985) 893-3427
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
018419
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1389579
—
LA
01
—
721166765
TAX ID
LA
Enumeration date
07/05/2005
Last updated
04/23/2019
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