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Individual

MICHAEL SHELLEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNP

Contact information

Practice address
818 CONGRESS ST, PORTLAND, ME 04102-3112
(207) 773-8161
Mailing address
818 CONGRESS ST, PORTLAND, ME 04102-3112
(207) 773-8161

Taxonomy

Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
CNP211203
ME
363LA2100X
Acute Care Nurse Practitioner
R213763
MD
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
01/29/2019
Last updated
08/12/2021
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