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General NPI Number Information
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NPI Number | 1669462149
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Entity Type | Individual
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Provider Name | CAROLE E SHELLEY M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/25/2005
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Last Update Date | 07/19/2012
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Provider Practice Location Address
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Address Line | 777 HOSPITAL WAY SUITE 300
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City | POCATELLO
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State | ID
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Zip | 83201-5176
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Country | US
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Telephone | 208-239-3461
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Fax | 208-239-3425
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Provider Business Mailing Address
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Address Line | 777 HOSPITAL WAY SUTIE 300
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City | POCATELLO
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State | ID
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Zip | 83201-5176
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Country | US
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Telephone | 208-239-3461
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Fax | 208-239-3425
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 31911
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | M-10122
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License Number State | ID
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