Provider Demographics
NPI:1780448803
Name:KRATOFIL, SHAWN ELLIOTT (MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:ELLIOTT
Last Name:KRATOFIL
Suffix:
Gender:M
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25650 HURON ST
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3703
Mailing Address - Country:US
Mailing Address - Phone:760-887-4842
Mailing Address - Fax:
Practice Address - Street 1:25650 HURON ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3703
Practice Address - Country:US
Practice Address - Phone:760-887-4842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028814363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily