Provider Demographics
NPI:1174068795
Name:WASHICHEK, SHELBA MARLENE (RN)
Entity type:Individual
Prefix:MRS
First Name:SHELBA
Middle Name:MARLENE
Last Name:WASHICHEK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 APACHE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-9489
Mailing Address - Country:US
Mailing Address - Phone:575-420-1583
Mailing Address - Fax:
Practice Address - Street 1:505 W PINE LODGE RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-9470
Practice Address - Country:US
Practice Address - Phone:575-627-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR39665163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool