Provider Demographics
NPI:1184852097
Name:CARLISLE, SHELLEY ARLENE (LPN)
Entity Type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:ARLENE
Last Name:CARLISLE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:SHELLEY
Other - Middle Name:ARLENE
Other - Last Name:REICHLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:524 E PERRY ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-3730
Mailing Address - Country:US
Mailing Address - Phone:330-277-1424
Mailing Address - Fax:330-337-7315
Practice Address - Street 1:524 E PERRY ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-3730
Practice Address - Country:US
Practice Address - Phone:330-277-1424
Practice Address - Fax:330-337-7315
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH121025 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse