Individual
MRS. SHELLEY LYNN VANACKEREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1908 N 203RD ST STE 3, ELKHORN, NE 68022-2889
(402) 289-5013
(402) 289-5018
Mailing address
1908 N 203RD ST STE 3, ELKHORN, NE 68022-2889
(402) 289-5013
(402) 289-5018
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
296
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
099709
MEDICARE GROUP
—
05
—
10025112300
—
NE
01
—
216812
COVENTRY
—
01
—
39960
BCBS
—
01
—
41213595668022A002
TRI WEST
—
Enumeration date
02/24/2009
Last updated
02/24/2009
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