MEDICARE: SHELLEY PAULSEN WHNP-BC

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	363LW0102X	Women's Health Nurse Practitioner	4704191984	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518963586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLEY PAULSEN WHNP-BC

Provider Business Mailing Address
First Line	:	1101 EMMET ST
Second Line	:
City	:	PETOSKEY
State	:	MI
Zip	:	49770-2963
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1003 SPRING ST
Second Line	:
City	:	PETOSKEY
State	:	MI
Zip	:	49770-2810
Country	:	US
Telephone Number	:	231-347-9692
Fax Number	:	231-348-1908

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	02/14/2012

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