Basic Information
| Provider Information | |||||||||
| NPI: | 1043811565 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERL | ||||||||
| FirstName: | SHANNON | ||||||||
| MiddleName: | NANELLE | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 415 | ||||||||
| Address2: | |||||||||
| City: | HOXIE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 677400415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7856753018 | ||||||||
| FaxNumber: | 7856752306 | ||||||||
| Practice Location | |||||||||
| Address1: | 826 18TH ST STE A | ||||||||
| Address2: | |||||||||
| City: | HOXIE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 677404371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7856753018 | ||||||||
| FaxNumber: | 7856752306 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2020 | ||||||||
| LastUpdateDate: | 11/02/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 53-79801-052 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.