Healthcare Provider Details

I. General information

NPI: 1942202494
Provider Name (Legal Business Name): SHIRLEY R COUREY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHIRLEY R TREDEAU NP

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 S SUPERIOR AVE
BARAGA MI
49908-9673
US

IV. Provider business mailing address

102 S SUPERIOR AVE
BARAGA MI
49908-9673
US

V. Phone/Fax

Practice location:
  • Phone: 406-534-4558
  • Fax: 406-281-8002
Mailing address:
  • Phone: 406-534-4558
  • Fax: 406-281-8002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704245825
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704245825
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: