Provider Demographics
NPI:1114301165
Name:CONNER, SHELLY MARIE (CRNP)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:MARIE
Last Name:CONNER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:
Other - Last Name:HAMMEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1201 GRAMPIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1900
Mailing Address - Country:US
Mailing Address - Phone:570-326-8723
Mailing Address - Fax:
Practice Address - Street 1:900 PLAZA DR
Practice Address - Street 2:
Practice Address - City:MONTOURSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17754-2448
Practice Address - Country:US
Practice Address - Phone:570-368-3321
Practice Address - Fax:570-601-5875
Is Sole Proprietor?:No
Enumeration Date:2015-07-18
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22865363LF0000X
WVAPRN 82589-NP-C363LF0000X
PASP015543363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily