Provider Demographics
NPI:1134810484
Name:MENARD, SHELLY (RN)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:MENARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 BUTTERFIELD DR STE 100
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3411
Mailing Address - Country:US
Mailing Address - Phone:248-530-9655
Mailing Address - Fax:
Practice Address - Street 1:2250 BUTTERFIELD DR STE 100
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3411
Practice Address - Country:US
Practice Address - Phone:248-530-9655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704273992163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator