Provider Demographics
NPI:1740755628
Name:DEVANT, SHELLY L (RN)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:L
Last Name:DEVANT
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:N4912 COUNTY ROAD P # 1
Mailing Address - Street 2:
Mailing Address - City:HELENVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53137-9763
Mailing Address - Country:US
Mailing Address - Phone:414-651-0030
Mailing Address - Fax:
Practice Address - Street 1:N4912 COUNTY ROAD P # 1
Practice Address - Street 2:
Practice Address - City:HELENVILLE
Practice Address - State:WI
Practice Address - Zip Code:53137-9763
Practice Address - Country:US
Practice Address - Phone:414-651-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI156989-30163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management