Provider Demographics
NPI:1003126129
Name:HASSELMAN, SHELLEY R (NP)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:R
Last Name:HASSELMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2482
Mailing Address - Street 2:
Mailing Address - City:RUNNING SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92382-2482
Mailing Address - Country:US
Mailing Address - Phone:909-867-2814
Mailing Address - Fax:909-337-5353
Practice Address - Street 1:29099 HOSPITAL ROAD
Practice Address - Street 2:SUITE 204B
Practice Address - City:LAKE ARROWHEAD
Practice Address - State:CA
Practice Address - Zip Code:92352
Practice Address - Country:US
Practice Address - Phone:909-337-7771
Practice Address - Fax:909-337-5353
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA626568163W00000X
CA20149363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse