Healthcare Provider Details

I. General information

NPI: 1861795445
Provider Name (Legal Business Name): CARMEN RENEE SHORE-ANDERSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2010
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 SUMNER ST
LINCOLN NE
68502-2048
US

IV. Provider business mailing address

4800 HOSPITAL PKWY
BEATRICE NE
68310-6906
US

V. Phone/Fax

Practice location:
  • Phone: 402-438-7958
  • Fax:
Mailing address:
  • Phone: 402-228-3344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number39461
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number111191
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: