Healthcare Provider Details

I. General information

NPI: 1063696755
Provider Name (Legal Business Name): KAY J SHULTS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 LAURENS ST
OLEAN NY
14760-2511
US

IV. Provider business mailing address

203 LAURENS ST
OLEAN NY
14760-2511
US

V. Phone/Fax

Practice location:
  • Phone: 716-373-8080
  • Fax: 716-373-8093
Mailing address:
  • Phone: 716-373-8080
  • Fax: 716-373-8093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number224092
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: