Individual
MRS. SHELBY LYNN ICENHOWER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
1235 E CHEROKEE ST, SPRINGFIELD, MO 65804-2203
(417) 820-2115
Mailing address
1235 E CHEROKEE ST, SPRINGFIELD, MO 65804-2203
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2021031470
MO
Other
Enumeration date
09/01/2021
Last updated
09/01/2021
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