Provider Demographics
NPI:1962547638
Name:PELKEY, SHANNA L (RN)
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:L
Last Name:PELKEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 GAFFNEY RD STOP 7400
Mailing Address - Street 2:
Mailing Address - City:FORT WAINWRIGHT
Mailing Address - State:AK
Mailing Address - Zip Code:99703-5007
Mailing Address - Country:US
Mailing Address - Phone:907-361-5825
Mailing Address - Fax:
Practice Address - Street 1:1AD HHC 2BDE
Practice Address - Street 2:CMR 405 BOX 1395
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09034
Practice Address - Country:DE
Practice Address - Phone:01515-821-0568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKNURR37215163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN