Provider Demographics
NPI:1932182698
Name:WALSMAN, SHELLY MARIE (NP)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:MARIE
Last Name:WALSMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 N MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47240-1487
Mailing Address - Country:US
Mailing Address - Phone:812-663-7277
Mailing Address - Fax:812-663-8986
Practice Address - Street 1:955 N MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:IN
Practice Address - Zip Code:47240-1487
Practice Address - Country:US
Practice Address - Phone:812-663-7277
Practice Address - Fax:812-663-8986
Is Sole Proprietor?:No
Enumeration Date:2005-11-26
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001063A363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200172780Medicaid
IN255510KMedicare PIN
P98633Medicare UPIN
IN178730MMedicare PIN