Provider Demographics
NPI:1992292353
Name:VLIET, SHELLY RENEE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:SHELLY
Middle Name:RENEE
Last Name:VLIET
Suffix:
Gender:
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3955 PATIENT CARE DR STE A
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4271
Mailing Address - Country:US
Mailing Address - Phone:517-374-7600
Mailing Address - Fax:885-480-9150
Practice Address - Street 1:839 S PUTNAM ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:MI
Practice Address - Zip Code:48895-1623
Practice Address - Country:US
Practice Address - Phone:517-655-3515
Practice Address - Fax:855-476-0189
Is Sole Proprietor?:No
Enumeration Date:2018-04-20
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704273069363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily