MEDICARE: SHELBY LYNN EARLS

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	163W00000X	Registered Nurse	94515	WV

General Provider Information

NPI Number	:	1033704648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBY LYNN EARLS

Provider Business Mailing Address
First Line	:	106 SAND MINE RD STE 1
Second Line	:
City	:	BERKELEY SPRINGS
State	:	WV
Zip	:	25411-7457
Country	:	US
Telephone Number	:	304-258-3096
Fax Number	:	304-258-3190

Provider Business Practice Location Address
First Line	:	SENIOR LIFE SERVICES OF MORGAN COUNTY
Second Line	:	106 SAND MINE RD SUITE 1
City	:	BERKELEY SPRINGS
State	:	WV
Zip	:	25411-2541
Country	:	US
Telephone Number	:	304-258-3096
Fax Number	:	304-258-3190

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

Provider Enumeration Date	:	03/05/2021
Last Update Date	:	03/05/2021

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