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General NPI Number Information
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NPI Number | 1699915165
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Entity Type | Individual
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Provider Name | MRS. SHELLEY LYNN VANACKEREN
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Gender | Female
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Dates
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Enumeration Date | 02/24/2009
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Last Update Date | 02/24/2009
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Provider Practice Location Address
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Address Line | 1908 N 203RD ST STE 3
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City | ELKHORN
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State | NE
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Zip | 68022-2889
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Country | US
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Telephone | 402-289-5013
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Fax | 402-289-5018
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Provider Business Mailing Address
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Address Line | 1908 N 203RD ST STE 3
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City | ELKHORN
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State | NE
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Zip | 68022-2889
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Country | US
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Telephone | 402-289-5013
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Fax | 402-289-5018
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 296
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License Number State | NE
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