Provider Demographics
NPI:1659763753
Name:MILLER, SHELLY (CRNP)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 JACKINS SETTLEMENT RD
Mailing Address - Street 2:
Mailing Address - City:HODGDON
Mailing Address - State:ME
Mailing Address - Zip Code:04730-4332
Mailing Address - Country:US
Mailing Address - Phone:207-521-1560
Mailing Address - Fax:
Practice Address - Street 1:22 NORTH ST
Practice Address - Street 2:
Practice Address - City:HOULTON
Practice Address - State:ME
Practice Address - Zip Code:04730-1833
Practice Address - Country:US
Practice Address - Phone:207-835-3214
Practice Address - Fax:207-407-7126
Is Sole Proprietor?:No
Enumeration Date:2015-02-26
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP2018089381363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health