Provider Demographics
NPI:1659926699
Name:SPENCE, SHELBY LYNN (RN)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:LYNN
Last Name:SPENCE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-2725
Mailing Address - Country:US
Mailing Address - Phone:507-429-7078
Mailing Address - Fax:
Practice Address - Street 1:107 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:COCHRANE
Practice Address - State:WI
Practice Address - Zip Code:54622-7311
Practice Address - Country:US
Practice Address - Phone:715-497-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI233786-30163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health