Provider Demographics
NPI:1952818049
Name:MACELROY, SHAWNIE GLORIA (RN)
Entity Type:Individual
Prefix:
First Name:SHAWNIE
Middle Name:GLORIA
Last Name:MACELROY
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 1:700 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:RATON
Mailing Address - State:NM
Mailing Address - Zip Code:87740-2719
Mailing Address - Country:US
Mailing Address - Phone:575-445-9261
Mailing Address - Fax:575-445-5306
Practice Address - Street 1:700 E 4TH ST
Practice Address - Street 2:
Practice Address - City:RATON
Practice Address - State:NM
Practice Address - Zip Code:87740-2719
Practice Address - Country:US
Practice Address - Phone:575-445-9261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR42633163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool