Provider Demographics
NPI:1306074265
Name:ST. GERMAIN, SHELLEY R (CRNA)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:R
Last Name:ST. GERMAIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:L
Other - Last Name:ROPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1314 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301
Mailing Address - Country:US
Mailing Address - Phone:601-703-9687
Mailing Address - Fax:601-703-9920
Practice Address - Street 1:1314 19TH AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301
Practice Address - Country:US
Practice Address - Phone:601-703-4282
Practice Address - Fax:601-703-4597
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERNA223001367500000X
MSR866144367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered