Active NPI
Shelley Eaton Van Wave, LPN
- Licensed Vocational Nurse
- Mansfield, OH
National Provider Identifier
1215399688
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Vocational Nurse
- License
- 48436
- Practice address
- 3163 Touby Rd
Mansfield, OH 44903-6912 - Phone
- (720) 402-6771
- NPI assigned
- Mar 24, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Vocational Nurse | 164X00000X | 48436 | CO | Primary |
Addresses
Primary practice location
3163 Touby Rd
Mansfield, OH 44903-6912
Mailing address
3163 Touby Rd
Mansfield, OH 44903-6912
Phone (720) 402-6771
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215399688 | Medicaid | CO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 48436 | CO | MD | Anatomic Pathology & Clinical Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1458777600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1541376000000",
"number": "1215399688",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3163 TOUBY RD",
"city": "MANSFIELD",
"state": "OH",
"postal_code": "449036912",
"telephone_number": "720-402-6771"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3163 TOUBY RD",
"city": "MANSFIELD",
"state": "OH",
"postal_code": "449036912",
"telephone_number": "720-402-6771"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN WAVE",
"first_name": "SHELLEY",
"middle_name": "EATON",
"credential": "LPN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-03-24",
"last_updated": "2018-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "164X00000X",
"taxonomy_group": "",
"desc": "Licensed Vocational Nurse",
"state": "CO",
"license": "48436",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1215399688",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mansfield, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.