Provider Demographics
NPI:1164863775
Name:GEILE, SHAWN LENN (APRN FNP BC)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:LENN
Last Name:GEILE
Suffix:
Gender:M
Credentials:APRN FNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:59 SWAN LN
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-7679
Mailing Address - Country:US
Mailing Address - Phone:573-431-2588
Mailing Address - Fax:
Practice Address - Street 1:108 FRIZZELL ST
Practice Address - Street 2:
Practice Address - City:POTOSI
Practice Address - State:MO
Practice Address - Zip Code:63664-1505
Practice Address - Country:US
Practice Address - Phone:573-438-8500
Practice Address - Fax:573-438-8787
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-11
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013024404363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO268647OtherRHC