Healthcare Provider Details

I. General information

NPI: 1487021259
Provider Name (Legal Business Name): SHELLY ROOPE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2015
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 HALEY CT
SANGERVILLE ME
04479-3000
US

IV. Provider business mailing address

22 HALEY CT
SANGERVILLE ME
04479-3000
US

V. Phone/Fax

Practice location:
  • Phone: 207-876-4811
  • Fax: 207-876-4302
Mailing address:
  • Phone: 207-876-4811
  • Fax: 207-876-4302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP151099
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: