Provider Demographics
NPI:1336981513
Name:PEMBERTON, SHELLY RENEE
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:RENEE
Last Name:PEMBERTON
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 1:300 TOWNSHIP ROAD 253 W
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-6039
Mailing Address - Country:US
Mailing Address - Phone:770-905-7277
Mailing Address - Fax:
Practice Address - Street 1:300 TOWNSHIP ROAD 253 W
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-6039
Practice Address - Country:US
Practice Address - Phone:770-905-7277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide