Provider Demographics
NPI:1255650537
Name:FERRARI, SHELLY ANNE (FNP)
Entity Type:Individual
Prefix:MS
First Name:SHELLY
Middle Name:ANNE
Last Name:FERRARI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 N CULLEN AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-2124
Mailing Address - Country:US
Mailing Address - Phone:626-963-9992
Mailing Address - Fax:
Practice Address - Street 1:623 N CULLEN AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-2124
Practice Address - Country:US
Practice Address - Phone:626-963-9992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19763363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health