Doctor Name: | SHELTON M HISLEY |
NPI Number: | 1891829008 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | OB GYN NP |
License Number: | 051074 |
Business Practice Address: | 25 Courthouse Dr. Ne Bolivia, NC - 28422 |
Business Phone Number: | 9102532250 |
Business Fax Number: | 9102532370 |
Mailing Address: | 4336 Loblolly Cir Se, SOUTHPORT |
State: | NC |
Postal Code: | 284618491 |
Phone Number: | 9102533353 |
Fax Number: | |
NPI Enumeration Date: | 03/16/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LX0001X |
License Number: | 051074 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Obstetrics & Gynecology |
Taxonomy Definition: |