Provider Demographics
NPI:1053407981
Name:OTOUPALIK, SHELLEY SMITH (ACNP)
Entity type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:SMITH
Last Name:OTOUPALIK
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7473 GROOMS RD
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-9798
Mailing Address - Country:US
Mailing Address - Phone:406-240-7396
Mailing Address - Fax:
Practice Address - Street 1:7473 GROOMS RD
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-9798
Practice Address - Country:US
Practice Address - Phone:406-240-7396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT22481363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner