1942669338 NPI number — MRS. BEVERLY ANN SHELL LPN-NURSE

Table of content: MRS. BEVERLY ANN SHELL LPN-NURSE (NPI 1942669338)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942669338 NPI number — MRS. BEVERLY ANN SHELL LPN-NURSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHELL
Provider First Name:
BEVERLY
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPN-NURSE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942669338
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
155 EISENHOWER AVENUE
Provider Second Line Business Mailing Address:
155 EISENHOWER AVENUE
Provider Business Mailing Address City Name:
WINNEMUCCA
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-304-2081
Provider Business Mailing Address Fax Number:
775-575-2384

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
FORT MCDERMITT WELLNESS CENTER
Provider Second Line Business Practice Location Address:
SUITE 702G
Provider Business Practice Location Address City Name:
MCDERMITT
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
98421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-532-8522
Provider Business Practice Location Address Fax Number:
775-575-2384
Provider Enumeration Date:
02/15/2016

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 164W00000X , with the licence number: LPN15624 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com