Provider Demographics
NPI:1568055614
Name:KLEIN, SHELBY JANET (AGACNP)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:JANET
Last Name:KLEIN
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12005 W TONTO ST
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-5711
Mailing Address - Country:US
Mailing Address - Phone:623-256-3815
Mailing Address - Fax:
Practice Address - Street 1:12005 W TONTO ST
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-5711
Practice Address - Country:US
Practice Address - Phone:623-256-3815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ254321363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care