Provider Demographics
NPI:1023888443
Name:SHIRLEY-WOOKIL, BETH R
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:R
Last Name:SHIRLEY-WOOKIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 S TORREY PINES DR UNIT 1229
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-0611
Mailing Address - Country:US
Mailing Address - Phone:702-659-2346
Mailing Address - Fax:
Practice Address - Street 1:5201 S TORREY PINES DR UNIT 1229
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-0611
Practice Address - Country:US
Practice Address - Phone:702-659-2346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN89264163WA2000X, 163WC0400X, 163W00000X
NVNUMBERRN89264163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WH1000XNursing Service ProvidersRegistered NurseHospice