Provider Demographics
NPI:1104117746
Name:NELSON, SHELLEY KATHLEEN (MD)
Entity type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:KATHLEEN
Last Name:NELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5625 S 62ND ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-3558
Mailing Address - Country:US
Mailing Address - Phone:402-489-3834
Mailing Address - Fax:402-489-5049
Practice Address - Street 1:5625 S 62ND ST STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-3558
Practice Address - Country:US
Practice Address - Phone:402-489-3834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-01
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE29036208000000X
IN01073647A2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics