Provider Demographics
NPI:1558834812
Name:MAST, SHELLEY MOSELEY (LVN)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:MOSELEY
Last Name:MAST
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 1:3103 E CARTWRIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93725-9385
Mailing Address - Country:US
Mailing Address - Phone:559-498-7100
Mailing Address - Fax:559-498-7111
Practice Address - Street 1:3103 E CARTWRIGHT AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93725-9385
Practice Address - Country:US
Practice Address - Phone:559-498-7100
Practice Address - Fax:559-498-7111
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN203024164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse