Provider Demographics
NPI:1265785653
Name:SLUSS, SHELLY LYNN
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:LYNN
Last Name:SLUSS
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 1:1009 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-3013
Mailing Address - Country:US
Mailing Address - Phone:419-357-3603
Mailing Address - Fax:
Practice Address - Street 1:1009 CLINTON ST
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-3013
Practice Address - Country:US
Practice Address - Phone:419-357-3603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-109180-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse