Provider Demographics
NPI:1710054929
Name:SHANLEY, CELIA B (RN)
Entity Type:Individual
Prefix:MS
First Name:CELIA
Middle Name:B
Last Name:SHANLEY
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 1:8200 KERN AVE
Mailing Address - Street 2:APARTMENT # H 202
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-4036
Mailing Address - Country:US
Mailing Address - Phone:408-674-1714
Mailing Address - Fax:
Practice Address - Street 1:290 I O O F AVE
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-5204
Practice Address - Country:US
Practice Address - Phone:408-846-2157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA414679163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse