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General NPI Number Information
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NPI Number | 1275682437
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Entity Type | Individual
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Provider Name | SHELLIANN MARIE ENDLINE-MCCLARY FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 770 KENMOOR AVE SE STE 100
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-8602
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Country | US
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Telephone | 616-272-3533
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Fax | 616-259-4839
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Provider Business Mailing Address
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Address Line | 801 ROSEHILL RD
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City | JACKSON
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State | MI
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Zip | 49202-1762
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Country | US
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Telephone | 615-627-2293
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704176891
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License Number State | MI
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