MEDICARE: SHEILA MICHELLE FASZOLD RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency
2	163WE0003X	Emergency Registered Nurse	041411990	IL

General Provider Information

NPI Number	:	1013441146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEILA MICHELLE FASZOLD RN

Provider Business Mailing Address
First Line	:	1109 HARTMAN LN STE 200
Second Line	:
City	:	SHILOH
State	:	IL
Zip	:	62221-7916
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1109 HARTMAN LN STE 200
Second Line	:
City	:	SHILOH
State	:	IL
Zip	:	62221-7916
Country	:	US
Telephone Number	:	314-920-2415
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2017
Last Update Date	:	02/27/2026

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