Provider Demographics
NPI:1013689488
Name:SHELTON, THERESA MARIE (NNP-BC)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7417 MONAD RD
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59106-2610
Mailing Address - Country:US
Mailing Address - Phone:406-861-0783
Mailing Address - Fax:
Practice Address - Street 1:7417 MONAD RD
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59106-2610
Practice Address - Country:US
Practice Address - Phone:406-861-0783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-177258363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal