Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | NUR-APRN-LIC-177258 | MT |
NPI | 1013689488 |
---|---|
Provider Name | Theresa Marie Shelton |
First Address | Billings, MT 59106-2610 |
Second Address | Billings, MT 59106-2610 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2021 |
Last Update Date | 04/10/2021 |