Healthcare Provider Details

I. General information

NPI: 1124302260
Provider Name (Legal Business Name): MELISSA ANN SHREWSBURY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2011
Last Update Date: 04/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 12TH ST STE A
PRINCETON WV
24740-2312
US

IV. Provider business mailing address

PO BOX 1369
PRINCETON WV
24740-1369
US

V. Phone/Fax

Practice location:
  • Phone: 304-487-3407
  • Fax: 304-487-2203
Mailing address:
  • Phone: 304-487-3407
  • Fax: 304-487-2203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number75286
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: