Provider Demographics
NPI:1164642500
Name:BRIAN, SHELLI MARIE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:SHELLI
Middle Name:MARIE
Last Name:BRIAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12794 WEST PASARO DRIVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383
Mailing Address - Country:US
Mailing Address - Phone:928-501-5555
Mailing Address - Fax:
Practice Address - Street 1:8841 E BELL RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1591
Practice Address - Country:US
Practice Address - Phone:602-865-0901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2452363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily