Healthcare Provider Details

I. General information

NPI: 1265484950
Provider Name (Legal Business Name): SHELLY HERRINGTON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S STATE ST
BASSETT NE
68714-5062
US

IV. Provider business mailing address

801 S STATE ST
BASSETT NE
68714-5062
US

V. Phone/Fax

Practice location:
  • Phone: 402-684-2906
  • Fax: 402-684-3822
Mailing address:
  • Phone: 402-684-2906
  • Fax: 402-684-3822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number110661
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: