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General NPI Number Information
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NPI Number | 1114659497
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Entity Type | Individual
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Provider Name | DEVRA LYNN SHETLER
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Gender | Female
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Dates
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Enumeration Date | 06/27/2022
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Last Update Date | 06/27/2022
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Provider Practice Location Address
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Address Line | ROBERT J. DOLE VA MEDICAL CENTER 5500 E KELLOGG DR
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City | WICHITA
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State | KS
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Zip | 67218
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Country | US
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Telephone | 316-685-2221
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Fax |
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Provider Business Mailing Address
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Address Line | 1451 N GRIMES ST
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City | MCPHERSON
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State | KS
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Zip | 67460-1912
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 44082
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License Number State | KS
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