Healthcare Provider Details

I. General information

NPI: 1538970280
Provider Name (Legal Business Name): SHELBY L ROSE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2025
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 SOUTH BLVD E STE 300
ROCHESTER HILLS MI
48307-6120
US

IV. Provider business mailing address

2495 CLINTON HILLS RD
ORTONVILLE MI
48462-8930
US

V. Phone/Fax

Practice location:
  • Phone: 248-884-9710
  • Fax: 248-884-9711
Mailing address:
  • Phone: 734-552-6910
  • Fax: 248-884-9711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704327031
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: