Provider Demographics
NPI:1568053668
Name:SHELBY, REBECCA RENE (PHLEBOTOMIST)
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:RENE
Last Name:SHELBY
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:RENE
Other - Last Name:SHELBY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1995 S SCHUYLER AVE TRLR G11
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-6215
Mailing Address - Country:US
Mailing Address - Phone:312-485-4199
Mailing Address - Fax:
Practice Address - Street 1:1995 S SCHUYLER AVE TRLR G11
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-6215
Practice Address - Country:US
Practice Address - Phone:312-485-4199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty