Healthcare Provider Details

I. General information

NPI: 1629858576
Provider Name (Legal Business Name): SHELBY DAWN WHITLOW MSN RN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BLYTHE BLVD 11A TRAUMA STEP-DOWN
CHARLOTTE NC
28203-5812
US

IV. Provider business mailing address

1829 PARSON ST
CHARLOTTE NC
28205-2359
US

V. Phone/Fax

Practice location:
  • Phone: 704-355-6311
  • Fax:
Mailing address:
  • Phone: 704-562-6788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number217127
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: