Provider Demographics
NPI:1366600652
Name:SHELLENBERGER, DONNA F (RN)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:F
Last Name:SHELLENBERGER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4939 KAPPUS DR
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-2910
Mailing Address - Country:US
Mailing Address - Phone:715-864-1033
Mailing Address - Fax:
Practice Address - Street 1:4939 KAPPUS DR
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-2910
Practice Address - Country:US
Practice Address - Phone:715-864-1033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI131260030163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35016900Medicaid