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NPI Code Detail

MEDICARE: MRS. KATHERINE ANNE SHELTON LPN

MEDICARE: MRS. KATHERINE ANNE SHELTON LPN
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
1164W00000XLicensed Practical Nurse4703088261MI

General Provider Information

NPI Number : 1700220266
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KATHERINE ANNE SHELTON LPN
Provider Business Mailing Address
First Line : 997 E REMUS RD
Second Line :
City : MOUNT PLEASANT
State : MI
Zip : 48858-9073
Country : US
Telephone Number : 616-406-6849
Fax Number :
Provider Business Practice Location Address
First Line : 209 E CHIPPEWA ST
Second Line :
City : MOUNT PLEASANT
State : MI
Zip : 48858-1609
Country : US
Telephone Number : 989-330-1135
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2013
Last Update Date : 04/26/2013

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