Provider Demographics
NPI:1013327063
Name:SHIMIZU, MARIA MICHELE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:MICHELE
Last Name:SHIMIZU
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4787 DANBURY CIR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-6952
Mailing Address - Country:US
Mailing Address - Phone:916-837-4498
Mailing Address - Fax:
Practice Address - Street 1:4787 DANBURY CIR
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-6952
Practice Address - Country:US
Practice Address - Phone:916-837-4498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95000630163WG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0100XNursing Service ProvidersRegistered NurseGastroenterology