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NPI Code Detail

MEDICARE: MS. EILEEN SHULT RN,GNP C

MEDICARE: MS. EILEEN SHULT RN,GNP C
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
1363LG0600XGerontology Nurse Practitioner672791TX
2363LG0600XGerontology Nurse PractitionerCNP-01549NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578514790
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. EILEEN SHULT RN,GNP C
Provider Business Mailing Address
First Line : PO BOX 14232
Second Line :
City : LAS CRUCES
State : NM
Zip : 88013-4232
Country : US
Telephone Number : 575-532-5455
Fax Number : 575-532-5641
Provider Business Practice Location Address
First Line : 2450 S TELSHOR BLVD
Second Line :
City : LAS CRUCES
State : NM
Zip : 88011-5069
Country : US
Telephone Number : 575-532-5455
Fax Number : 575-532-5641
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2006
Last Update Date : 07/13/2011

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