Provider Demographics
NPI:1033796156
Name:AMES, SHEILA M
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:M
Last Name:AMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:M
Other - Last Name:AMES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSN, RN, PHN
Mailing Address - Street 1:PO BOX 561
Mailing Address - Street 2:
Mailing Address - City:WILLITS
Mailing Address - State:CA
Mailing Address - Zip Code:95490-0561
Mailing Address - Country:US
Mailing Address - Phone:707-234-8595
Mailing Address - Fax:
Practice Address - Street 1:25530 ARCHER LN
Practice Address - Street 2:
Practice Address - City:WILLITS
Practice Address - State:CA
Practice Address - Zip Code:95490-9572
Practice Address - Country:US
Practice Address - Phone:707-367-0706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA763277163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA861414047OtherPRIVATE INSURANCE
CA861414047Medicaid