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NPI Code Detail

MEDICARE: SHELLEY BATES LPN

MEDICARE: SHELLEY BATES 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 NurseLP013145AZ

General Provider Information

NPI Number : 1972639771
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHELLEY BATES LPN
Provider Business Mailing Address
First Line : 5601 N 16TH ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-2903
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5601 N 16TH ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-2903
Country : US
Telephone Number : 602-664-7931
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2007
Last Update Date : 07/08/2007

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