Provider Demographics
NPI:1629512413
Name:SCHULTZ, RAYMOND L (PA)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:L
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:PA
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Other - Last Name:
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Mailing Address - Street 1:201 TAHOMA BLVD UNIT 102
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-7735
Mailing Address - Country:US
Mailing Address - Phone:360-458-7761
Mailing Address - Fax:360-706-1183
Practice Address - Street 1:201 TAHOMA BLVD UNIT 102
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-7735
Practice Address - Country:US
Practice Address - Phone:360-458-7761
Practice Address - Fax:360-706-1183
Is Sole Proprietor?:No
Enumeration Date:2016-12-13
Last Update Date:2025-07-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NH1464363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3116834Medicaid