Provider Demographics
NPI:1518593128
Name:SHOUSE, ELIZABETH YVONNE (RN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:YVONNE
Last Name:SHOUSE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 E PACIFIC COAST HWY APT 231
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-2041
Mailing Address - Country:US
Mailing Address - Phone:562-665-7591
Mailing Address - Fax:
Practice Address - Street 1:3801 E PACIFIC COAST HWY APT 231
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-2041
Practice Address - Country:US
Practice Address - Phone:562-665-7591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-14
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95142162163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse