Provider Demographics
NPI:1477955763
Name:ALVARADO, SHELLY (CRNA)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:ALVARADO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3906 TWILIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-3613
Mailing Address - Country:US
Mailing Address - Phone:580-554-4725
Mailing Address - Fax:
Practice Address - Street 1:3906 TWILIGHT AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-3613
Practice Address - Country:US
Practice Address - Phone:580-554-4725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0062520367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered