Healthcare Provider Details

I. General information

NPI: 1275682437
Provider Name (Legal Business Name): SHELLIANN MARIE ENDLINE-MCCLARY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHEILLIANN MARIE THREADGILL NP

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 KENMOOR AVE SE STE 100
GRAND RAPIDS MI
49546-8602
US

IV. Provider business mailing address

801 ROSEHILL RD
JACKSON MI
49202-1762
US

V. Phone/Fax

Practice location:
  • Phone: 616-272-3533
  • Fax: 616-259-4839
Mailing address:
  • Phone: 615-627-2293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704176891
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: