Provider Demographics
NPI:1891062105
Name:SHRESTHA, IRA (CRNP)
Entity Type:Individual
Prefix:
First Name:IRA
Middle Name:
Last Name:SHRESTHA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6025 HIDDEN WAY LN
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-2369
Mailing Address - Country:US
Mailing Address - Phone:256-490-5176
Mailing Address - Fax:
Practice Address - Street 1:6920 MIRAMAR RD STE 305
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2643
Practice Address - Country:US
Practice Address - Phone:888-435-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-111664363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily