Provider Demographics
NPI:1417126947
Name:DESHAN, SHELLY KAY (LVN)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:KAY
Last Name:DESHAN
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 1:206 CANYON HIGHLANDS DR
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966-3741
Mailing Address - Country:US
Mailing Address - Phone:707-363-6551
Mailing Address - Fax:
Practice Address - Street 1:206 CANYON HIGHLANDS DR
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-3741
Practice Address - Country:US
Practice Address - Phone:707-363-6551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA201770164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse