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NPI Code Detail

MEDICARE: REBECCA JO SHIRLEY C.N.P.

MEDICARE: REBECCA JO SHIRLEY C.N.P.
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
1363L00000XNurse PractitionerNP-04761OH

General Provider Information

NPI Number : 1285695775
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA JO SHIRLEY C.N.P.
Provider Business Mailing Address
First Line : 725 S SHOOP AVE
Second Line :
City : WAUSEON
State : OH
Zip : 43567-1702
Country : US
Telephone Number : 419-330-2772
Fax Number : 419-330-2771
Provider Business Practice Location Address
First Line : 725 S SHOOP AVE
Second Line :
City : WAUSEON
State : OH
Zip : 43567-1702
Country : US
Telephone Number : 419-330-2772
Fax Number : 419-330-2771
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2006
Last Update Date : 02/06/2024

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