Healthcare Provider Details

I. General information

NPI: 1255940862
Provider Name (Legal Business Name): MARILYN JEAN SHELEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 HOSPITAL AVE STE 105
DU BOIS PA
15801-1463
US

IV. Provider business mailing address

145 HOSPITAL AVE STE 105
DU BOIS PA
15801-1463
US

V. Phone/Fax

Practice location:
  • Phone: 814-375-3890
  • Fax: 814-375-3893
Mailing address:
  • Phone: 814-375-3890
  • Fax: 814-375-3893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN502579L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: