Provider Demographics
NPI:1326338856
Name:JETLEY, SHALINI (LVN)
Entity Type:Individual
Prefix:
First Name:SHALINI
Middle Name:
Last Name:JETLEY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12800 GARDEN GROVE BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-2008
Mailing Address - Country:US
Mailing Address - Phone:714-620-8131
Mailing Address - Fax:714-620-8132
Practice Address - Street 1:12800 GARDEN GROVE BLVD STE F
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-2008
Practice Address - Country:US
Practice Address - Phone:714-620-8131
Practice Address - Fax:714-620-8132
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN249746164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse