MEDICARE: JANET MARIAN SHAULIS RN,BSN

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
1	146L00000X	Paramedic	2508	NE
2	163WE0003X	Emergency Registered Nurse	RN079839	LA
3	163WE0003X	Emergency Registered Nurse	687968	CA
4	163WF0300X	Flight Registered Nurse	54448	NE

General Provider Information

NPI Number	:	1760647879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET MARIAN SHAULIS RN,BSN

Provider Business Mailing Address
First Line	:	2039 ELIZABETH DR
Second Line	:
City	:	MITCHELL
State	:	NE
Zip	:	69357-1040
Country	:	US
Telephone Number	:	308-641-0773
Fax Number	:

Provider Business Practice Location Address
First Line	:	2039 ELIZABETH DR
Second Line	:
City	:	MITCHELL
State	:	NE
Zip	:	69357-1040
Country	:	US
Telephone Number	:	308-641-0773
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2008
Last Update Date	:	07/29/2008

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