Provider Demographics
NPI:1043397169
Name:DEL VECCHIO, SHANA KRISTIN (NP)
Entity type:Individual
Prefix:MRS
First Name:SHANA
Middle Name:KRISTIN
Last Name:DEL VECCHIO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:SHANA
Other - Middle Name:KRISTIN
Other - Last Name:BODEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:901 S NATIONAL AVE
Mailing Address - Street 2:TAYLOR HEALTH & WELLNESS CENTER
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65897
Mailing Address - Country:US
Mailing Address - Phone:417-836-4000
Mailing Address - Fax:417-836-4133
Practice Address - Street 1:901 S NATIONAL AVE
Practice Address - Street 2:TAYLOR HEALTH & WELLNESS CENTER
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65897
Practice Address - Country:US
Practice Address - Phone:417-836-4000
Practice Address - Fax:417-836-4133
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO132O39363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner