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NPI Code Detail

MEDICARE: RUTH S SHEALY NP

MEDICARE: RUTH S SHEALY NP
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
1363LG0600XGerontology Nurse Practitioner29093SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1750329694
Entity Type Code : Individual
Provider Name (Legal Business Name) : RUTH S SHEALY NP
Provider Business Mailing Address
First Line : 22580 HIGHWAY 76 E
Second Line : SUITE 100
City : LAURENS
State : SC
Zip : 29360-8439
Country : US
Telephone Number : 864-833-5986
Fax Number : 864-833-0599
Provider Business Practice Location Address
First Line : 22580 HIGHWAY 76 E
Second Line : SUITE 100
City : LAURENS
State : SC
Zip : 29360-8439
Country : US
Telephone Number : 864-833-5986
Fax Number : 864-833-0599
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2006
Last Update Date : 03/04/2014

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