Provider Demographics
NPI:1184190613
Name:FEHR, SHELBY LAINE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:LAINE
Last Name:FEHR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:SHELBY
Other - Middle Name:
Other - Last Name:KOEHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:816 KICKAPOO DR
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:IL
Mailing Address - Zip Code:61732-9047
Mailing Address - Country:US
Mailing Address - Phone:309-212-4214
Mailing Address - Fax:
Practice Address - Street 1:815 MAIN ST
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61602-1076
Practice Address - Country:US
Practice Address - Phone:309-672-4977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.411087163W00000X
IL209.018341363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse