Provider Demographics
NPI:1265840045
Name:PETER, SHAWNTELLE D
Entity Type:Individual
Prefix:
First Name:SHAWNTELLE
Middle Name:D
Last Name:PETER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:ONEILL
Mailing Address - State:NE
Mailing Address - Zip Code:68763-1565
Mailing Address - Country:US
Mailing Address - Phone:402-340-3922
Mailing Address - Fax:
Practice Address - Street 1:118 N 5TH ST
Practice Address - Street 2:
Practice Address - City:ONEILL
Practice Address - State:NE
Practice Address - Zip Code:68763-1565
Practice Address - Country:US
Practice Address - Phone:402-340-3922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker