Provider Demographics
NPI:1417844267
Name:PEDERSEN, SHIRLEY
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:PEDERSEN
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:PO BOX 116
Mailing Address - Street 2:
Mailing Address - City:BLADEN
Mailing Address - State:NE
Mailing Address - Zip Code:68928-0116
Mailing Address - Country:US
Mailing Address - Phone:402-460-7243
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 116
Practice Address - Street 2:
Practice Address - City:BLADEN
Practice Address - State:NE
Practice Address - Zip Code:68928-0116
Practice Address - Country:US
Practice Address - Phone:402-460-7243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant