Provider Demographics
NPI:1598894396
Name:TRUMBLY, SHELLEY R (RN)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:R
Last Name:TRUMBLY
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 1:630 GRIFFITH LN
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-9370
Mailing Address - Country:US
Mailing Address - Phone:541-891-9462
Mailing Address - Fax:
Practice Address - Street 1:630 GRIFFITH LN
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-9370
Practice Address - Country:US
Practice Address - Phone:541-891-9462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR098239Medicaid