Healthcare Provider Details

I. General information

NPI: 1508290792
Provider Name (Legal Business Name): SHELBY LORRAINE UNDERHILL RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2013
Last Update Date: 08/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SW 10TH AVE
TOPEKA KS
66604-1301
US

IV. Provider business mailing address

3120 SW 32ND ST
TOPEKA KS
66614-2736
US

V. Phone/Fax

Practice location:
  • Phone: 785-357-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: