Healthcare Provider Details

I. General information

NPI: 1699774653
Provider Name (Legal Business Name): KRISTA ELLEN SHEDLOSKY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 N COLLEGE AND LOUTHER ST
CARLISLE PA
17013
US

IV. Provider business mailing address

312 W MAIN ST
SHIREMANSTOWN PA
17011-6332
US

V. Phone/Fax

Practice location:
  • Phone: 717-245-1835
  • Fax: 717-245-1938
Mailing address:
  • Phone: 717-731-9241
  • Fax: 717-245-1938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License NumberRN187048L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: