Provider Demographics
NPI:1699097196
Name:MILTON, SHELLY ANN (RN, BSN)
Entity type:Individual
Prefix:MS
First Name:SHELLY
Middle Name:ANN
Last Name:MILTON
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 WASH HOUSE CIR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21769-7743
Mailing Address - Country:US
Mailing Address - Phone:240-277-3942
Mailing Address - Fax:
Practice Address - Street 1:28 WASH HOUSE CIR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:MD
Practice Address - Zip Code:21769-7743
Practice Address - Country:US
Practice Address - Phone:240-277-3942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1008279163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse