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General NPI Number Information
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NPI Number | 1558259754
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Entity Type | Individual
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Provider Name | MRS. SHELBY RENEE MOHR
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Gender | Female
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Dates
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Enumeration Date | 06/25/2025
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 2200 E WASHINGTON ST
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City | BLOOMINGTON
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State | IL
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Zip | 61701-4364
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Country | US
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Telephone | 217-671-2886
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Fax |
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Provider Business Mailing Address
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Address Line | 23202 N 950 EAST RD
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City | CARLOCK
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State | IL
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Zip | 61725-9474
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Country | US
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Telephone | 217-671-2886
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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 | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | 209.032607
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License Number State | IL
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