| NPI | 1770605909 |
|---|---|
| Former Name | SHELLY S VANDER VELDEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 833930) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP60644432) |
| 363L00000X Nurse Practitioner (Licence: AZ AP3667) | |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2021-12-16 |