Provider Demographics
NPI:1013465202
Name:HURLEY, SHAWN ROBERT (NP-C)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:ROBERT
Last Name:HURLEY
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9747 CALDARO ST
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-3577
Mailing Address - Country:US
Mailing Address - Phone:909-476-2190
Mailing Address - Fax:
Practice Address - Street 1:9747 CALDARO ST
Practice Address - Street 2:
Practice Address - City:ALTA LOMA
Practice Address - State:CA
Practice Address - Zip Code:91737-3577
Practice Address - Country:US
Practice Address - Phone:909-476-2190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95004548363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP95004548Medicaid
CANP95004548Medicare Oscar/Certification
CANP95004548Medicare PIN
CANP95004548Medicaid