Provider Demographics
NPI:1033634241
Name:EARL, SHIRLEY ANN (NP)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:ANN
Last Name:EARL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 JOHN COOK RD
Mailing Address - Street 2:
Mailing Address - City:UNADILLA
Mailing Address - State:NY
Mailing Address - Zip Code:13849-2219
Mailing Address - Country:US
Mailing Address - Phone:607-434-7110
Mailing Address - Fax:
Practice Address - Street 1:1 FOXCARE DR
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2099
Practice Address - Country:US
Practice Address - Phone:607-376-0145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF308228-1363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology