Individual
JENNIFER LYNN SHULL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP-BC
Contact information
Practice address
1383 W HUNTER ST, LOGAN, OH 43138-1013
(740) 385-0202
(740) 380-2734
Mailing address
PO BOX 228, LOGAN, OH 43138-0228
(740) 385-0202
(740) 380-2734
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
COA 11967-NP
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3152725
—
OH
Enumeration date
10/25/2010
Last updated
10/26/2020
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