Individual
JOSHUA MICHAEL SHELLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3307 HALLIDAY AVE, SAINT LOUIS, MO 63118-1211
(314) 368-0286
Mailing address
3307 HALLIDAY AVE, SAINT LOUIS, MO 63118-1211
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2005021478
MO
367500000X
Certified Registered Nurse Anesthetist
Primary
2014011359
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2005021478
MISSOUIR NURISING LICENSE
MO
Enumeration date
02/12/2014
Last updated
04/24/2014
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