Provider Demographics
NPI:1740534874
Name:SHELTON, DEVONA K (LPN)
Entity type:Individual
Prefix:
First Name:DEVONA
Middle Name:K
Last Name:SHELTON
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 1:22410 STATE ROUTE 136
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45697-9733
Mailing Address - Country:US
Mailing Address - Phone:937-695-0024
Mailing Address - Fax:
Practice Address - Street 1:22410 STATE ROUTE 136
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:45697-9733
Practice Address - Country:US
Practice Address - Phone:937-695-0024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH150425-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse