Healthcare Provider Details

I. General information

NPI: 1316286925
Provider Name (Legal Business Name): CARLA J SHILTS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2013
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 HAZEN ST
PAW PAW MI
49079-2008
US

IV. Provider business mailing address

PO BOX 249
PAW PAW MI
49079-0249
US

V. Phone/Fax

Practice location:
  • Phone: 517-716-5081
  • Fax: 269-657-6902
Mailing address:
  • Phone: 269-657-5574
  • Fax: 269-657-6902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704238767
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: