Provider Demographics
NPI:1053011643
Name:SHOCKLEY, PAULA DENISE (LPN)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:DENISE
Last Name:SHOCKLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3414 N MILTON ST
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-1937
Mailing Address - Country:US
Mailing Address - Phone:765-254-5602
Mailing Address - Fax:765-254-5603
Practice Address - Street 1:3401 N MORRISON RD
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-5568
Practice Address - Country:US
Practice Address - Phone:765-254-5602
Practice Address - Fax:765-254-5603
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27027839A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse