Provider Demographics
NPI:1396402004
Name:GEORGETTI, SHELBY LYNN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:LYNN
Last Name:GEORGETTI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:SHELBY
Other - Middle Name:LYNN
Other - Last Name:WADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:WELLSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26070-1982
Mailing Address - Country:US
Mailing Address - Phone:304-794-8836
Mailing Address - Fax:
Practice Address - Street 1:951 E MARKET ST
Practice Address - Street 2:
Practice Address - City:CADIZ
Practice Address - State:OH
Practice Address - Zip Code:43907-9799
Practice Address - Country:US
Practice Address - Phone:740-942-4631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV110254363LF0000X
OHAPRN.CNP.0030213363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily