Provider Demographics
NPI:1295503589
Name:SHELLEY, TERESA ANN (RN)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:ANN
Last Name:SHELLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:A
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2500 W SIMS WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-2234
Mailing Address - Country:US
Mailing Address - Phone:360-385-0610
Mailing Address - Fax:360-379-8259
Practice Address - Street 1:2500 W SIMS WAY STE 300
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-2234
Practice Address - Country:US
Practice Address - Phone:360-385-0610
Practice Address - Fax:360-379-8259
Is Sole Proprietor?:No
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00089005163W00000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse