Provider Demographics
NPI:1356462048
Name:SHELBY, WINNIFRED DEBBRA (NP)
Entity Type:Individual
Prefix:MRS
First Name:WINNIFRED
Middle Name:DEBBRA
Last Name:SHELBY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:WINNIFRED
Other - Middle Name:DEBBRA
Other - Last Name:CROTEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 89
Mailing Address - Street 2:
Mailing Address - City:PAULDEN
Mailing Address - State:AZ
Mailing Address - Zip Code:86334-0089
Mailing Address - Country:US
Mailing Address - Phone:760-792-3000
Mailing Address - Fax:
Practice Address - Street 1:500 N US HIGHWAY 89
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86313-5001
Practice Address - Country:US
Practice Address - Phone:928-445-4860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA317876163W00000X
CA11583363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMC0712035OtherDEA
CAP48461Medicare UPIN
CAZZZ22147ZMedicare ID - Type Unspecified