Provider Demographics
NPI:1417585902
Name:FOLEY, SHELLEY ANNE (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:ANNE
Last Name:FOLEY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MS
Other - First Name:SHELLEY
Other - Middle Name:ANNE
Other - Last Name:WANTAJA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:1001 S. KNIK GOOSE BAY ROAD
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654
Mailing Address - Country:US
Mailing Address - Phone:907-631-7312
Mailing Address - Fax:907-631-7623
Practice Address - Street 1:1001 S. KNIK GOOSE BAY ROAD
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654
Practice Address - Country:US
Practice Address - Phone:907-631-7312
Practice Address - Fax:907-631-7623
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK158314363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily