Individual
NICOLE SHANLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
175 GWINNETT DR, LAWRENCEVILLE, GA 30046-8444
(678) 209-2394
Mailing address
6264 SHOREVIEW CIR, FLOWERY BRANCH, GA 30542-7604
(515) 343-7919
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
Primary
2923288
GA
Other
Enumeration date
06/23/2022
Last updated
06/23/2022
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