Provider Demographics
NPI:1225185986
Name:SHAMBLIN, SUSAN C
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:C
Last Name:SHAMBLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SUSIE
Other - Middle Name:C
Other - Last Name:SHAMBLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 11867
Mailing Address - Street 2:CORRECTIONAL HEALTH DIVISION, 2ND FLOOR
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93775-1867
Mailing Address - Country:US
Mailing Address - Phone:559-600-3229
Mailing Address - Fax:559-445-2772
Practice Address - Street 1:1225 M STREET
Practice Address - Street 2:CORRECTIONAL HEALTH 2ND FLOOR
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1905
Practice Address - Country:US
Practice Address - Phone:559-442-2404
Practice Address - Fax:559-442-5277
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA168264164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse