Provider Demographics
NPI:1700556313
Name:ALLAN, SHELBY (RN)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:ALLAN
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 1:13800 W WOOD RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WOOD RIVER
Mailing Address - State:NE
Mailing Address - Zip Code:68883-9456
Mailing Address - Country:US
Mailing Address - Phone:308-583-2249
Mailing Address - Fax:308-583-2668
Practice Address - Street 1:13800 W WOOD RIVER RD
Practice Address - Street 2:
Practice Address - City:WOOD RIVER
Practice Address - State:NE
Practice Address - Zip Code:68883-9456
Practice Address - Country:US
Practice Address - Phone:308-583-2249
Practice Address - Fax:308-583-2668
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE80199163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool