Healthcare Provider Details

I. General information

NPI: 1134118136
Provider Name (Legal Business Name): LINDA S SHENTON ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1436 RIVERCHASE BLVD
ROCK HILL SC
29732-1777
US

IV. Provider business mailing address

1436 RIVERCHASE BLVD
ROCK HILL SC
29732-1777
US

V. Phone/Fax

Practice location:
  • Phone: 803-329-2636
  • Fax: 803-329-2184
Mailing address:
  • Phone: 803-329-2636
  • Fax: 803-329-2184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPN1015
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: