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NPI Code Detail

MEDICARE: SHIRLEY KING RN

MEDICARE: SHIRLEY KING RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse4453551NY

General Provider Information

NPI Number : 1245778836
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHIRLEY KING RN
Provider Business Mailing Address
First Line : 2039 GORDEN RIDGE DR
Second Line :
City : EAST STROUDSBURG
State : PA
Zip : 18302-8468
Country : US
Telephone Number : 570-517-1215
Fax Number :
Provider Business Practice Location Address
First Line : 2039 GORDEN RIDGE DR
Second Line :
City : EAST STROUDSBURG
State : PA
Zip : 18302-8468
Country : US
Telephone Number : 570-517-1215
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2017
Last Update Date : 02/03/2017

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