Provider Demographics
NPI:1740949635
Name:MOTT, SHELBY NOLEN (CNA)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:NOLEN
Last Name:MOTT
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:NOLEN
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:5015 37TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-1101
Mailing Address - Country:US
Mailing Address - Phone:701-955-4052
Mailing Address - Fax:
Practice Address - Street 1:5015 37TH AVE NW
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-1101
Practice Address - Country:US
Practice Address - Phone:701-955-4052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No251E00000XAgenciesHome Health