Provider Demographics
NPI:1558259754
Name:MOHR, SHELBY RENEE
Entity type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:RENEE
Last Name:MOHR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23202 N 950 EAST RD
Mailing Address - Street 2:
Mailing Address - City:CARLOCK
Mailing Address - State:IL
Mailing Address - Zip Code:61725-9474
Mailing Address - Country:US
Mailing Address - Phone:217-671-2886
Mailing Address - Fax:
Practice Address - Street 1:2200 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-4364
Practice Address - Country:US
Practice Address - Phone:217-671-2886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.032607207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services