Provider Demographics
NPI:1568854156
Name:FELLER, SHAWN M (RN)
Entity Type:Individual
Prefix:MRS
First Name:SHAWN
Middle Name:M
Last Name:FELLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1858 OLD VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-3370
Mailing Address - Country:US
Mailing Address - Phone:920-819-4906
Mailing Address - Fax:920-498-0945
Practice Address - Street 1:1537 PARK PL
Practice Address - Street 2:SUITE 200
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-1974
Practice Address - Country:US
Practice Address - Phone:920-498-8650
Practice Address - Fax:920-498-0945
Is Sole Proprietor?:No
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI85339163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care