Basic Information
| Provider Information | |||||||||
| NPI: | 1871219808 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPANGLER | ||||||||
| FirstName: | SHELBY | ||||||||
| MiddleName: | ALAYNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3810 | ||||||||
| Address2: | |||||||||
| City: | JOPLIN | ||||||||
| State: | MO | ||||||||
| PostalCode: | 648033810 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 510 PARK ST | ||||||||
| Address2: | |||||||||
| City: | ANDERSON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 648319280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178450545 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2022 | ||||||||
| LastUpdateDate: | 11/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 2018023663 | MO | N | Nursing Service Providers | Registered Nurse | 363L00000X | 2022044132 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.