MEDICARE: MR. CHARLES A SHEELEY II MSN, APN

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	363LG0600X	Gerontology Nurse Practitioner	APN000662	NV

General Provider Information

NPI Number	:	1225048184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES A SHEELEY II MSN, APN

Provider Business Mailing Address
First Line	:	10405 CHADWELL DR
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89521-4206
Country	:	US
Telephone Number	:	775-852-5769
Fax Number	:	775-322-6191

Provider Business Practice Location Address
First Line	:	50 KIRMAN AVE
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89502-1175
Country	:	US
Telephone Number	:	775-322-5050
Fax Number	:	775-322-6191

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

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	07/08/2007

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