Provider Demographics
NPI:1043022239
Name:SHADLEY, RACHEL VERLYNN
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:VERLYNN
Last Name:SHADLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5339 W MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68524-2140
Mailing Address - Country:US
Mailing Address - Phone:402-942-2426
Mailing Address - Fax:
Practice Address - Street 1:2521 AMMON AVE
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68507-2737
Practice Address - Country:US
Practice Address - Phone:402-942-2426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant