Provider Demographics
NPI:1275395121
Name:LILLEY, SHELLEY (RN)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:LILLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 508
Mailing Address - Street 2:
Mailing Address - City:MOUNDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26041-0508
Mailing Address - Country:US
Mailing Address - Phone:304-843-4400
Mailing Address - Fax:304-843-5095
Practice Address - Street 1:214 MIDDLE GRAVE CREEK ROAD
Practice Address - Street 2:
Practice Address - City:MOUNDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26041-0508
Practice Address - Country:US
Practice Address - Phone:304-843-4400
Practice Address - Fax:304-843-5095
Is Sole Proprietor?:No
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV83393163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool