Provider Demographics
NPI:1356516520
Name:COUNTS, SHELLY (RN, BSN)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:COUNTS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71780 SAN JACINTO DR
Mailing Address - Street 2:SUITE B3
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-5516
Mailing Address - Country:US
Mailing Address - Phone:760-341-3501
Mailing Address - Fax:760-341-3099
Practice Address - Street 1:71780 SAN JACINTO DR
Practice Address - Street 2:SUITE B3
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-5516
Practice Address - Country:US
Practice Address - Phone:760-341-3501
Practice Address - Fax:760-341-3099
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA597391163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy