Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | SP010810 | PA |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | SP017385 | PA |
NPI | 1033439757 |
---|---|
Provider Name | James Shellem |
First Address | Elizabethtown, PA 17022-1773 |
Second Address | Elizabethtown, PA 17022-1773 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2010 |
Last Update Date | 23/07/2020 |