Provider Demographics
NPI:1235945379
Name:PERSINGER, SHELLY R
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:R
Last Name:PERSINGER
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 1:377 S DELAWARE ST APT 203
Mailing Address - Street 2:
Mailing Address - City:MOUNT GILEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43338-3005
Mailing Address - Country:US
Mailing Address - Phone:419-834-3246
Mailing Address - Fax:
Practice Address - Street 1:377 S DELAWARE ST APT 203
Practice Address - Street 2:
Practice Address - City:MOUNT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338-3005
Practice Address - Country:US
Practice Address - Phone:419-834-3246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400120000502376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty