Provider Demographics
NPI:1124202460
Name:CHAVIRA, SHELLY RENEE (LVN)
Entity Type:Individual
Prefix:MS
First Name:SHELLY
Middle Name:RENEE
Last Name:CHAVIRA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MS
Other - First Name:SHELLY
Other - Middle Name:
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1206 G ST
Mailing Address - Street 2:KINGSVIEW HOUSING & RECOVERY
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-1643
Mailing Address - Country:US
Mailing Address - Phone:559-459-0334
Mailing Address - Fax:559-459-0339
Practice Address - Street 1:1206 G ST
Practice Address - Street 2:KINGSVIEW
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-1643
Practice Address - Country:US
Practice Address - Phone:559-459-0334
Practice Address - Fax:559-459-0339
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA199365164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse