Provider Demographics
NPI:1629396049
Name:FAWLEY, SHIRLEY IRIS
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:IRIS
Last Name:FAWLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4636 GLENGATE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-6151
Mailing Address - Country:US
Mailing Address - Phone:614-332-1495
Mailing Address - Fax:
Practice Address - Street 1:4636 GLENGATE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-6151
Practice Address - Country:US
Practice Address - Phone:614-332-1495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide