Provider Demographics
NPI:1760693386
Name:SHELTS, LINDA DIANE (RN)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:DIANE
Last Name:SHELTS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 KNIGHTS BRIDGE DR N
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-9597
Mailing Address - Country:US
Mailing Address - Phone:614-833-5103
Mailing Address - Fax:
Practice Address - Street 1:114 KNIGHTS BRIDGE DR N
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-9597
Practice Address - Country:US
Practice Address - Phone:614-833-5103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN214076163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2301459Medicaid
OH2539533Medicaid