Individual
SHELLY L GUDEHUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1125 MADISON ST, JEFFERSON CITY, MO 65101-5227
(573) 632-5580
(573) 632-5876
Mailing address
1125 MADISON ST, JEFFERSON CITY, MO 65101-5227
(573) 632-5580
(573) 632-5876
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
133429
MO
363LF0000X
Family Nurse Practitioner
Primary
133429
MO
363LF0000X
Family Nurse Practitioner
209000687
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
133429
MO LICENSE
MO
01
—
RN LICENSE
041319304
IL
Enumeration date
02/21/2006
Last updated
11/08/2016
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