Provider Demographics
NPI:1700220266
Name:SHELTON, KATHERINE ANNE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:ANNE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:997 E REMUS RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-9073
Mailing Address - Country:US
Mailing Address - Phone:616-406-6849
Mailing Address - Fax:
Practice Address - Street 1:209 E CHIPPEWA ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-1609
Practice Address - Country:US
Practice Address - Phone:989-330-1135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703088261164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse