Provider Demographics
NPI:1255568523
Name:OLES, SHELLY MARIE (DNP, ANP-BC)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:MARIE
Last Name:OLES
Suffix:
Gender:F
Credentials:DNP, ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 W SHIAWASSEE AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-2093
Mailing Address - Country:US
Mailing Address - Phone:810-354-8100
Mailing Address - Fax:810-354-8012
Practice Address - Street 1:9225 BAY PLAZA BLVD STE 417
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-4412
Practice Address - Country:US
Practice Address - Phone:810-354-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704229825363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health