Provider Demographics
NPI:1942202494
Name:COUREY, SHIRLEY R (NP)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:R
Last Name:COUREY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:R
Other - Last Name:TREDEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:102 S SUPERIOR AVE
Mailing Address - Street 2:
Mailing Address - City:BARAGA
Mailing Address - State:MI
Mailing Address - Zip Code:49908-9673
Mailing Address - Country:US
Mailing Address - Phone:406-534-4558
Mailing Address - Fax:406-281-8002
Practice Address - Street 1:102 S SUPERIOR AVE
Practice Address - Street 2:
Practice Address - City:BARAGA
Practice Address - State:MI
Practice Address - Zip Code:49908-9673
Practice Address - Country:US
Practice Address - Phone:406-534-4558
Practice Address - Fax:406-281-8002
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704245825363LA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q40576Medicare UPIN