Provider Demographics
NPI:1750180014
Name:NELSON, SHANIA ROSE MARIE
Entity type:Individual
Prefix:
First Name:SHANIA
Middle Name:ROSE MARIE
Last Name:NELSON
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 1:2531 S JEFFERSON ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-5638
Mailing Address - Country:US
Mailing Address - Phone:307-258-6742
Mailing Address - Fax:
Practice Address - Street 1:2531 S JEFFERSON ST APT 1
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-5638
Practice Address - Country:US
Practice Address - Phone:307-258-6742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health