Provider Demographics
NPI:1275682437
Name:ENDLINE, SHELLIANN MARIE (NP)
Entity Type:Individual
Prefix:MRS
First Name:SHELLIANN
Middle Name:MARIE
Last Name:ENDLINE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:SHEILLIANN
Other - Middle Name:MARIE
Other - Last Name:THREADGILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:801 ROSEHILL RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-1762
Mailing Address - Country:US
Mailing Address - Phone:615-627-2293
Mailing Address - Fax:
Practice Address - Street 1:770 KENMOOR AVE SE STE 100
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8602
Practice Address - Country:US
Practice Address - Phone:616-272-3533
Practice Address - Fax:616-259-4839
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704176891363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI50-0-87-0197-0OtherBCBSM PC
MI4560345 10Medicaid
MI50-0-87-0197-0OtherBCBSM PC