Provider Demographics
NPI:1720011265
Name:SHELLENBARGER, PAULA RAE (MSN FNP-C)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:RAE
Last Name:SHELLENBARGER
Suffix:
Gender:F
Credentials:MSN FNP-C
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:JOHNSON
Other - Last Name:SHELLENBARGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN FNP-C
Mailing Address - Street 1:1025 GARFIELD ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3930
Mailing Address - Country:US
Mailing Address - Phone:970-495-7420
Mailing Address - Fax:970-495-7609
Practice Address - Street 1:1025 GARFIELD ST
Practice Address - Street 2:SUITE B
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524
Practice Address - Country:US
Practice Address - Phone:970-495-7420
Practice Address - Fax:970-495-7609
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO57965363L00000X
COAPN.0002850-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07321571Medicaid
C550198Medicare PIN
S90610Medicare UPIN
CO334376YLB8Medicare PIN