Provider Demographics
NPI:1457194953
Name:VAN ROEKEL, SHELLI LYNN
Entity type:Individual
Prefix:MRS
First Name:SHELLI
Middle Name:LYNN
Last Name:VAN ROEKEL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4938 GOLDFINCH AVE
Mailing Address - Street 2:
Mailing Address - City:MAURICE
Mailing Address - State:IA
Mailing Address - Zip Code:51036-7554
Mailing Address - Country:US
Mailing Address - Phone:712-899-8176
Mailing Address - Fax:
Practice Address - Street 1:1111 11TH ST
Practice Address - Street 2:
Practice Address - City:HAWARDEN
Practice Address - State:IA
Practice Address - Zip Code:51023-1903
Practice Address - Country:US
Practice Address - Phone:712-551-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-13
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA130982163WM0705X
IAA179839363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical