Individual
SHELLEY EATON VAN WAVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3163 TOUBY RD, MANSFIELD, OH 44903-6912
(720) 402-6771
Mailing address
3163 TOUBY RD, MANSFIELD, OH 44903-6912
(720) 402-6771
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
48436
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1215399688
—
CO
Enumeration date
03/24/2016
Last updated
11/05/2018
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