Individual
SHELLY MARIE DALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
405 N DIVISION RD STE 2, PETOSKEY, MI 49770-9046
(231) 487-2270
Mailing address
9910 MISSION RD, ALANSON, MI 49706-9717
(231) 838-8454
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704216787
MI
Other
Enumeration date
07/01/2019
Last updated
07/01/2019
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