Provider Demographics
NPI:1760658280
Name:GILLESPIE, SHELLEY SMITH (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:SMITH
Last Name:GILLESPIE
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 1:114 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-3931
Mailing Address - Country:US
Mailing Address - Phone:804-233-1543
Mailing Address - Fax:
Practice Address - Street 1:114 E 14TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-3931
Practice Address - Country:US
Practice Address - Phone:804-233-1543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002065413164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse