Provider Demographics
NPI:1982881629
Name:SHELLENBERGER, ROBERTA ANN (RN)
Entity type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:ANN
Last Name:SHELLENBERGER
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 1:455 WILLOW
Mailing Address - Street 2:
Mailing Address - City:GLOBE
Mailing Address - State:AZ
Mailing Address - Zip Code:85501-2295
Mailing Address - Country:US
Mailing Address - Phone:928-402-5814
Mailing Address - Fax:928-425-8936
Practice Address - Street 1:455 WILLOW
Practice Address - Street 2:
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-2295
Practice Address - Country:US
Practice Address - Phone:928-402-5814
Practice Address - Fax:928-425-8936
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN030426163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool