1184852097 NPI number — MS. SHELLEY ARLENE CARLISLE LPN

Table of content: MS. SHELLEY ARLENE CARLISLE LPN (NPI 1184852097)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184852097 NPI number — MS. SHELLEY ARLENE CARLISLE LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARLISLE
Provider First Name:
SHELLEY
Provider Middle Name:
ARLENE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REICHLE
Provider Other First Name:
SHELLEY
Provider Other Middle Name:
ARLENE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184852097
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
524 E PERRY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44460-3730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-277-1424
Provider Business Mailing Address Fax Number:
330-337-7315

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
524 E PERRY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44460-3730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-277-1424
Provider Business Practice Location Address Fax Number:
330-337-7315
Provider Enumeration Date:
06/30/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164W00000X , with the licence number:  121025 IV , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)