Provider Demographics
NPI:1619212479
Name:SHELLEY, JANET L (FNP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:L
Last Name:SHELLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 940444
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:AK
Mailing Address - Zip Code:99694-0444
Mailing Address - Country:US
Mailing Address - Phone:907-892-0225
Mailing Address - Fax:
Practice Address - Street 1:950 E BOGARD RD
Practice Address - Street 2:SUITE 233
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7184
Practice Address - Country:US
Practice Address - Phone:907-357-4543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-05
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1325363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily