Healthcare Provider Details

I. General information

NPI: 1285605170
Provider Name (Legal Business Name): SHELLEY L. SPECTOR ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 01/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1228 E RUSHOLME ST SUITE 302
DAVENPORT IA
52803-2453
US

IV. Provider business mailing address

1228 E RUSHOLME ST SUITE 302
DAVENPORT IA
52803-2453
US

V. Phone/Fax

Practice location:
  • Phone: 563-823-9300
  • Fax: 563-823-9330
Mailing address:
  • Phone: 563-823-9300
  • Fax: 563-823-9330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License NumberS-085388
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: