Provider Demographics
NPI:1124784699
Name:RADOM, SHELBIE (MSN RN, IBCLC)
Entity type:Individual
Prefix:
First Name:SHELBIE
Middle Name:
Last Name:RADOM
Suffix:
Gender:F
Credentials:MSN RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1974 WINDOM PL
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-7033
Mailing Address - Country:US
Mailing Address - Phone:307-760-5462
Mailing Address - Fax:
Practice Address - Street 1:1974 WINDOM PL
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-7033
Practice Address - Country:US
Practice Address - Phone:307-760-5462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0183351163WM0102X, 163WP0200X, 163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WP0200XNursing Service ProvidersRegistered NursePediatrics