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General NPI Number Information
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NPI Number | 1184190613
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Entity Type | Individual
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Provider Name | SHELBY LAINE FEHR APRN
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Gender | Female
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Dates
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Enumeration Date | 10/23/2018
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Last Update Date | 10/23/2018
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Provider Practice Location Address
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Address Line | 815 MAIN ST
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City | PEORIA
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State | IL
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Zip | 61602-1076
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Country | US
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Telephone | 309-672-4977
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Fax |
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Provider Business Mailing Address
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Address Line | 816 KICKAPOO DR
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City | DANVERS
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State | IL
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Zip | 61732-9047
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Country | US
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Telephone | 309-212-4214
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041.411087
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.018341
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License Number State | IL
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