Provider Demographics
NPI:1073827739
Name:DIANE, SHELLEY (CNS)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:DIANE
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SHEMRAN CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930-1321
Mailing Address - Country:US
Mailing Address - Phone:415-721-0120
Mailing Address - Fax:415-353-1076
Practice Address - Street 1:1 SHEMRAN CT
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:CA
Practice Address - Zip Code:94930-1321
Practice Address - Country:US
Practice Address - Phone:415-721-0120
Practice Address - Fax:415-353-1076
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA468075163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics