Provider Demographics
NPI:1952878233
Name:SHIFFLET, WENDY ELIZABETH (PLMHP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:ELIZABETH
Last Name:SHIFFLET
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MC COOK
Mailing Address - State:NE
Mailing Address - Zip Code:69001-3712
Mailing Address - Country:US
Mailing Address - Phone:308-345-4884
Mailing Address - Fax:308-345-2366
Practice Address - Street 1:TRI VALLEY MEDICAL
Practice Address - Street 2:1305 HWY 6/34
Practice Address - City:CAMBRIDGE
Practice Address - State:NE
Practice Address - Zip Code:69022
Practice Address - Country:US
Practice Address - Phone:308-697-3310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11517101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health