Provider Demographics
NPI:1598102477
Name:RICH, SHIRLEY SHONTA (RN, ASSOCIATE DEGREE)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:SHONTA
Last Name:RICH
Suffix:
Gender:F
Credentials:RN, ASSOCIATE DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 E RANKIN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MS
Mailing Address - Zip Code:39429-8740
Mailing Address - Country:US
Mailing Address - Phone:601-441-5603
Mailing Address - Fax:
Practice Address - Street 1:214 E RANKIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429-8740
Practice Address - Country:US
Practice Address - Phone:601-441-5603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-31
Last Update Date:2014-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR886069163W00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse