Provider Demographics
NPI:1447481916
Name:SHIRLEY, ELAINE MARIE (NP)
Entity type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:MARIE
Last Name:SHIRLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:
Other - Last Name:HAUGLUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:6363 FRANCE AVE S
Mailing Address - Street 2:SUITE 400
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2129
Mailing Address - Country:US
Mailing Address - Phone:952-920-1445
Mailing Address - Fax:952-920-7444
Practice Address - Street 1:6363 FRANCE AVE S
Practice Address - Street 2:SUITE 400
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2129
Practice Address - Country:US
Practice Address - Phone:952-920-2070
Practice Address - Fax:952-920-7444
Is Sole Proprietor?:No
Enumeration Date:2009-08-01
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR154705-4363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health