Provider Demographics
NPI:1952108524
Name:PETERSON, RASHELLE MARCENE
Entity type:Individual
Prefix:
First Name:RASHELLE
Middle Name:MARCENE
Last Name:PETERSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:M
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NICKNAME
Mailing Address - Street 1:2635 PARK PLACE CIR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-3793
Mailing Address - Country:US
Mailing Address - Phone:402-720-5256
Mailing Address - Fax:
Practice Address - Street 1:2635 PARK PLACE CIR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-3793
Practice Address - Country:US
Practice Address - Phone:402-720-5256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372500000X372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider