Provider Demographics
NPI:1043590490
Name:SMITH, SHIRLEEN
Entity Type:Individual
Prefix:
First Name:SHIRLEEN
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NORTH PLATTE
Other - Middle Name:
Other - Last Name:NURSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:320 WILLIAM AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-6007
Mailing Address - Country:US
Mailing Address - Phone:308-530-7194
Mailing Address - Fax:308-532-0228
Practice Address - Street 1:320 WILLIAM AVE
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6007
Practice Address - Country:US
Practice Address - Phone:308-530-7194
Practice Address - Fax:308-532-0228
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE49066163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse