Provider Demographics
NPI:1982810628
Name:ROSS, SHELIE SMITH (CNM)
Entity Type:Individual
Prefix:
First Name:SHELIE
Middle Name:SMITH
Last Name:ROSS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 N MAIN
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:MI
Mailing Address - Zip Code:48872-9703
Mailing Address - Country:US
Mailing Address - Phone:517-290-3433
Mailing Address - Fax:
Practice Address - Street 1:505 N MAIN
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:MI
Practice Address - Zip Code:48872-9703
Practice Address - Country:US
Practice Address - Phone:517-290-3433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704184640367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife