Provider Demographics
NPI:1629554720
Name:MONTES, SHELLIE JACLYN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:SHELLIE
Middle Name:JACLYN
Last Name:MONTES
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12432 DEL SUR ST
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-4851
Mailing Address - Country:US
Mailing Address - Phone:928-551-5354
Mailing Address - Fax:
Practice Address - Street 1:18092 WIKA RD STE 130
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2132
Practice Address - Country:US
Practice Address - Phone:442-292-2358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95026695163WG0000X
CA95021427363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice