MEDICARE: SHIRLEY IKELER

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	164W00000X	Licensed Practical Nurse	4703084483	MI

General Provider Information

NPI Number	:	1538551775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRLEY IKELER

Provider Business Mailing Address
First Line	:	5048 TREEHILL RD
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-2052
Country	:	US
Telephone Number	:	810-730-2062
Fax Number	:

Provider Business Practice Location Address
First Line	:	5048 TREEHILL RD
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-2052
Country	:	US
Telephone Number	:	810-730-2062
Fax Number	:

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

Provider Enumeration Date	:	02/25/2015
Last Update Date	:	02/25/2015

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