Provider Demographics
NPI:1740299692
Name:SHETLER, DAVID HENRY (RN)
Entity type:Individual
Prefix:PROF
First Name:DAVID
Middle Name:HENRY
Last Name:SHETLER
Suffix:
Gender:M
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:HE&T USA MEDDAC
Mailing Address - Street 2:BUILDING 248-A, BARSTOW RD
Mailing Address - City:FORT IRWIN
Mailing Address - State:CA
Mailing Address - Zip Code:92310
Mailing Address - Country:US
Mailing Address - Phone:760-985-9621
Mailing Address - Fax:
Practice Address - Street 1:MEDDAC
Practice Address - Street 2:BUILDING 248-A, BARSTOW ROAD
Practice Address - City:FORT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310
Practice Address - Country:US
Practice Address - Phone:760-985-9621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR50665372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider