Provider Demographics
NPI:1801338074
Name:TUTTLE-SHAMP, STEPHANIE (LVN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:TUTTLE-SHAMP
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 S RIVERVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:REEDLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93654-3742
Mailing Address - Country:US
Mailing Address - Phone:559-393-6052
Mailing Address - Fax:
Practice Address - Street 1:1435 S RIVERVIEW AVE
Practice Address - Street 2:
Practice Address - City:REEDLEY
Practice Address - State:CA
Practice Address - Zip Code:93654-3742
Practice Address - Country:US
Practice Address - Phone:559-393-6052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-05
Last Update Date:2016-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN682375164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse