Provider Demographics
NPI:1750857264
Name:MEYER, SHELBY (ARNP)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:MEYER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:
Other - Last Name:SCHWENNEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:OLIN
Mailing Address - State:IA
Mailing Address - Zip Code:52320-9405
Mailing Address - Country:US
Mailing Address - Phone:563-370-8892
Mailing Address - Fax:
Practice Address - Street 1:3701 KATZ DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-3871
Practice Address - Country:US
Practice Address - Phone:319-377-3174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-23
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA128350363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA$$$$$$$$$Medicaid