MEDICARE: SHELBY LEE IRWIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	97322	NE

General Provider Information

NPI Number	:	1982436937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBY LEE IRWIN

Provider Business Mailing Address
First Line	:	7820 S 191ST ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68136-1226
Country	:	US
Telephone Number	:	402-515-3480
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 S 90TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68124-1201
Country	:	US
Telephone Number	:	402-515-3480
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2024
Last Update Date	:	02/20/2025

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Directions to “ SHELBY LEE IRWIN ” Practice Location

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