MEDICARE: MS. SHELLEY SMITH OTOUPALIK ACNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	22481	MT

General Provider Information

NPI Number	:	1053407981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHELLEY SMITH OTOUPALIK ACNP

Provider Business Mailing Address
First Line	:	7473 GROOMS RD
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59808-9798
Country	:	US
Telephone Number	:	406-240-7396
Fax Number	:

Provider Business Practice Location Address
First Line	:	7473 GROOMS RD
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59808-9798
Country	:	US
Telephone Number	:	406-240-7396
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	05/14/2015

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