Provider Demographics
NPI:1942669338
Name:SHELL, BEVERLY ANN (LPN-NURSE)
Entity type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:ANN
Last Name:SHELL
Suffix:
Gender:F
Credentials:LPN-NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 EISENHOWER AVENUE
Mailing Address - Street 2:155 EISENHOWER AVENUE
Mailing Address - City:WINNEMUCCA
Mailing Address - State:NV
Mailing Address - Zip Code:89445
Mailing Address - Country:US
Mailing Address - Phone:775-304-2081
Mailing Address - Fax:775-575-2384
Practice Address - Street 1:FORT MCDERMITT WELLNESS CENTER
Practice Address - Street 2:SUITE 702G
Practice Address - City:MCDERMITT
Practice Address - State:NV
Practice Address - Zip Code:98421
Practice Address - Country:US
Practice Address - Phone:775-532-8522
Practice Address - Fax:775-575-2384
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NVLPN15624164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health