Healthcare Provider Details

I. General information

NPI: 1770197535
Provider Name (Legal Business Name): GENNADY SHILING RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GENE SHILING RN

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 UVALDA ST
AURORA CO
80011-8602
US

IV. Provider business mailing address

22699 E IDA CIR
AURORA CO
80015-6669
US

V. Phone/Fax

Practice location:
  • Phone: 303-551-1610
  • Fax:
Mailing address:
  • Phone: 303-507-3623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number0169522
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: