MEDICARE: SHELBY MARIE LONDON FNP

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	969553	TX

General Provider Information

NPI Number	:	1417529850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBY MARIE LONDON FNP

Provider Business Mailing Address
First Line	:	12477 MERIT DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75251-2344
Country	:	US
Telephone Number	:	972-239-5300
Fax Number	:

Provider Business Practice Location Address
First Line	:	12477 MERIT DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75251-2344
Country	:	US
Telephone Number	:	972-239-5300
Fax Number	:

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

Provider Enumeration Date	:	07/14/2021
Last Update Date	:	07/14/2021

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