Provider Demographics
NPI:1235448432
Name:SHELTERS, LAURA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:SHELTERS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8463 STOCKTON RD
Mailing Address - Street 2:
Mailing Address - City:BROCTON
Mailing Address - State:NY
Mailing Address - Zip Code:14716-9723
Mailing Address - Country:US
Mailing Address - Phone:716-792-9485
Mailing Address - Fax:
Practice Address - Street 1:8463 STOCKTON RD
Practice Address - Street 2:
Practice Address - City:BROCTON
Practice Address - State:NY
Practice Address - Zip Code:14716-9723
Practice Address - Country:US
Practice Address - Phone:716-792-9485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY258090-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse