Healthcare Provider Details

I. General information

NPI: 1689871394
Provider Name (Legal Business Name): MARIANNE E SHELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 S MAIN ST
MIDDLETOWN OH
45044-4234
US

IV. Provider business mailing address

514 S MAIN ST
MIDDLETOWN OH
45044-4234
US

V. Phone/Fax

Practice location:
  • Phone: 513-261-9141
  • Fax:
Mailing address:
  • Phone: 513-261-9141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0300X
TaxonomyNephrology Registered Nurse
License NumberRN330412
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: