Provider Demographics
NPI:1558967844
Name:SHELTON, JAMIE LYNN (PHLEB)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:LYNN
Last Name:SHELTON
Suffix:
Gender:F
Credentials:PHLEB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 S STEPHENSON AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-4159
Mailing Address - Country:US
Mailing Address - Phone:906-239-6830
Mailing Address - Fax:
Practice Address - Street 1:201 RUBLEIN ST STE C
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4060
Practice Address - Country:US
Practice Address - Phone:313-953-8768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch