Provider Demographics
NPI:1932963642
Name:BURNS, SHELLY ANN
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:ANN
Last Name:BURNS
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 1:142 COUNTY ROAD 26
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:OH
Mailing Address - Zip Code:43435-9773
Mailing Address - Country:US
Mailing Address - Phone:419-455-4402
Mailing Address - Fax:
Practice Address - Street 1:142 COUNTY ROAD 26
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:OH
Practice Address - Zip Code:43435-9773
Practice Address - Country:US
Practice Address - Phone:419-455-4402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker