Provider Demographics
NPI:1033186127
Name:SHULL, PATRICIA LUCILE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:LUCILE
Last Name:SHULL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:404 N BROOKS AVE
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-2964
Mailing Address - Country:US
Mailing Address - Phone:307-259-4909
Mailing Address - Fax:307-685-6438
Practice Address - Street 1:501 S BURMA AVE
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3426
Practice Address - Country:US
Practice Address - Phone:307-688-9255
Practice Address - Fax:307-685-6438
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY416207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine