Provider Demographics
NPI:1629655048
Name:SHANNON, SHELLY ANN (LPN)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:ANN
Last Name:SHANNON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:GENTLE HANDS HOME
Other - Middle Name:CARE
Other - Last Name:LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:IN HOME CARE SERVICE
Mailing Address - Street 1:1115 ELM ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:NE
Mailing Address - Zip Code:68873-1907
Mailing Address - Country:US
Mailing Address - Phone:402-680-5563
Mailing Address - Fax:308-754-7876
Practice Address - Street 1:1115 ELM ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:NE
Practice Address - Zip Code:68873-1907
Practice Address - Country:US
Practice Address - Phone:402-680-5563
Practice Address - Fax:308-754-7876
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care