Provider Demographics
NPI:1396184198
Name:SHULTIS, CAROLE LYNN (FNP)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:LYNN
Last Name:SHULTIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CAROLE
Other - Middle Name:LYNN
Other - Last Name:ECKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:25 DREAM LN
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-6470
Mailing Address - Country:US
Mailing Address - Phone:703-498-9000
Mailing Address - Fax:
Practice Address - Street 1:337 MAPLE AVE E
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170855363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily