Provider Demographics
NPI:1457881252
Name:AGRUSA, SHELLEY EILEEN (RN)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:EILEEN
Last Name:AGRUSA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-2944
Mailing Address - Country:US
Mailing Address - Phone:562-753-2301
Mailing Address - Fax:562-753-2320
Practice Address - Street 1:1333 CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-2944
Practice Address - Country:US
Practice Address - Phone:562-753-2301
Practice Address - Fax:562-753-2320
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA541178163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care