Provider Demographics
NPI:1639237738
Name:CARLQUIST, SHIRLEY (LVN)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:CARLQUIST
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:
Other - Last Name:WADSWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1311 HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928
Mailing Address - Country:US
Mailing Address - Phone:530-345-0155
Mailing Address - Fax:
Practice Address - Street 1:592 RIO LINDO AVENUE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926
Practice Address - Country:US
Practice Address - Phone:530-891-2775
Practice Address - Fax:530-895-6547
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALVN180960164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALVN180960OtherST LICENSE #