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NPI Code Detail

MEDICARE: DEBORAH GRACE SHIRLEY RN

MEDICARE: DEBORAH GRACE SHIRLEY 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
1163WS0200XSchool Registered NurseRN00110573WA

General Provider Information

NPI Number : 1356777403
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBORAH GRACE SHIRLEY RN
Provider Business Mailing Address
First Line : 514 4TH ST
Second Line :
City : SULTAN
State : WA
Zip : 98294-9474
Country : US
Telephone Number : 360-793-9800
Fax Number :
Provider Business Practice Location Address
First Line : 514 4TH ST
Second Line :
City : SULTAN
State : WA
Zip : 98294-9474
Country : US
Telephone Number : 360-793-9800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2013
Last Update Date : 09/20/2013

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Directions to “ DEBORAH GRACE SHIRLEY RN” Practice Location

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