1720011265 NPI number — PAULA RAE SHELLENBARGER MSN FNP-C

Table of content: PAULA RAE SHELLENBARGER MSN FNP-C (NPI 1720011265)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720011265 NPI number — PAULA RAE SHELLENBARGER MSN FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHELLENBARGER
Provider First Name:
PAULA
Provider Middle Name:
RAE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHELLENBARGER
Provider Other First Name:
PAULA
Provider Other Middle Name:
JOHNSON
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSN FNP-C
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1720011265
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1025 GARFIELD ST
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
FORT COLLINS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80524-3930
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-495-7420
Provider Business Mailing Address Fax Number:
970-495-7609

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1025 GARFIELD ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
FORT COLLINS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-495-7420
Provider Business Practice Location Address Fax Number:
970-495-7609
Provider Enumeration Date:
07/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  57965 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: APN.0002850-NP , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 07321571 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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