Healthcare Provider Details

I. General information

NPI: 1194549063
Provider Name (Legal Business Name): SHELLEY ARETZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2024
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E KEARSLEY ST
FLINT MI
48502-1907
US

IV. Provider business mailing address

303 E KEARSLEY ST
FLINT MI
48502-1907
US

V. Phone/Fax

Practice location:
  • Phone: 810-762-3300
  • Fax:
Mailing address:
  • Phone: 810-762-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number4704408178
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: