Individual
MARY E SHY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-CS
Contact information
Practice address
PO BOX 608, WALSH, CO 81090-0608
(719) 543-6633
(719) 543-6655
Mailing address
PO BOX 608, WALSH, CO 81090-0608
(719) 543-6633
(719) 543-6655
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2312
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45253
KANSAS BOARD OF HEALING ARTS
—
05
—
58851747
—
CO
Enumeration date
09/26/2006
Last updated
06/07/2021
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