Healthcare Provider Details

I. General information

NPI: 1871576876
Provider Name (Legal Business Name): SHELLY JEANNE NORMAN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 01/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 SW WILLIAM AVE
CHEHALIS WA
98532-4730
US

IV. Provider business mailing address

112 MINES RD
WINLOCK WA
98596-9539
US

V. Phone/Fax

Practice location:
  • Phone: 360-748-8814
  • Fax: 925-364-2279
Mailing address:
  • Phone: 360-520-4795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30005011
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License NumberAP30005011
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: