Provider Demographics
NPI:1912706664
Name:ROSE, SHELLY MAE
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:MAE
Last Name:ROSE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 83
Mailing Address - Street 2:
Mailing Address - City:HAY SPRINGS
Mailing Address - State:NE
Mailing Address - Zip Code:69347-0083
Mailing Address - Country:US
Mailing Address - Phone:308-207-2184
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 138
Practice Address - Street 2:
Practice Address - City:GORDON
Practice Address - State:NE
Practice Address - Zip Code:69343-9738
Practice Address - Country:US
Practice Address - Phone:308-458-7814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion