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General NPI Number Information
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NPI Number | 1104465558
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Entity Type | Individual
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Provider Name | SHELLY CRANE AGNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/02/2020
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Last Update Date | 01/02/2020
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Provider Practice Location Address
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Address Line | 915 W EMMA AVE
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2531
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Country | US
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Telephone | 208-791-3391
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Fax |
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Provider Business Mailing Address
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Address Line | 2900 N GOVERNMENT WAY # 294
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City | COEUR D ALENE
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State | ID
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Zip | 83815-3751
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Country | US
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Telephone | 208-791-3391
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 39760
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License Number State | ID
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