Provider Demographics
NPI:1265568778
Name:ENDERLE, SHIRLEY (NP)
Entity type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:
Last Name:ENDERLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 MUTH DR
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-2819
Mailing Address - Country:US
Mailing Address - Phone:925-253-0798
Mailing Address - Fax:
Practice Address - Street 1:6955 FOOTHILL BLVD
Practice Address - Street 2:STE 300
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2409
Practice Address - Country:US
Practice Address - Phone:510-567-5731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA217485363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology