Provider Demographics
NPI:1578514790
Name:SHULT, EILEEN (RN,GNP C)
Entity Type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:
Last Name:SHULT
Suffix:
Gender:F
Credentials:RN,GNP C
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 14232
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88013-4232
Mailing Address - Country:US
Mailing Address - Phone:575-532-5455
Mailing Address - Fax:575-532-5641
Practice Address - Street 1:2450 S TELSHOR BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-5069
Practice Address - Country:US
Practice Address - Phone:575-532-5455
Practice Address - Fax:575-532-5641
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX672791363LG0600X
NMCNP-01549363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175602501Medicaid
TX175602502Medicaid
TX175602502Medicaid
TX175602501Medicaid
TXQ51151Medicare UPIN