Provider Demographics
NPI:1235967910
Name:SHELLEY, JAMIE LYN (CNM)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYN
Last Name:SHELLEY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 HAWTHORNE ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-1815
Mailing Address - Country:US
Mailing Address - Phone:320-287-1531
Mailing Address - Fax:
Practice Address - Street 1:621 HAWTHORNE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-1815
Practice Address - Country:US
Practice Address - Phone:320-335-1709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN588367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife