Provider Demographics
NPI:1417529850
Name:LONDON, SHELBY MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:MARIE
Last Name:LONDON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12477 MERIT DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-2344
Mailing Address - Country:US
Mailing Address - Phone:972-239-5300
Mailing Address - Fax:
Practice Address - Street 1:12477 MERIT DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-2344
Practice Address - Country:US
Practice Address - Phone:972-239-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX969553163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse