Provider Demographics
NPI:1487440699
Name:FONLEY, SHELBY MICHELE (APRN CNM)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:MICHELE
Last Name:FONLEY
Suffix:
Gender:F
Credentials:APRN CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 HIGHWAY 13 UNIT 118
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55120-1132
Mailing Address - Country:US
Mailing Address - Phone:352-470-9261
Mailing Address - Fax:
Practice Address - Street 1:624 SMITH AVE S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107-2620
Practice Address - Country:US
Practice Address - Phone:651-689-3988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN626363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Single Specialty