Provider Demographics
NPI:1528604709
Name:COLBURN, SHELBY ALEXANDRIA (NP)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:ALEXANDRIA
Last Name:COLBURN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11160 WARNER AVE STE 411
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4056
Mailing Address - Country:US
Mailing Address - Phone:714-513-1399
Mailing Address - Fax:714-513-1393
Practice Address - Street 1:11160 WARNER AVE STE 411
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4056
Practice Address - Country:US
Practice Address - Phone:714-513-1399
Practice Address - Fax:714-513-1393
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95212452163WX0003X
AL1-174014163WX0003X
CA95024839363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient