Provider Demographics
NPI:1295590024
Name:MANNEL, SHANELL LYNN (RD)
Entity type:Individual
Prefix:
First Name:SHANELL
Middle Name:LYNN
Last Name:MANNEL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 E DECARO LOOP
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-8169
Mailing Address - Country:US
Mailing Address - Phone:970-901-1434
Mailing Address - Fax:
Practice Address - Street 1:2009 E DECARO LOOP
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-8169
Practice Address - Country:US
Practice Address - Phone:970-901-1434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-20
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered