Provider Demographics
NPI:1881314854
Name:WHITING, SHELBY (RN)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:WHITING
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:
Other - Last Name:ICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4539 W BEAUTIFUL LN
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-7318
Mailing Address - Country:US
Mailing Address - Phone:661-427-8941
Mailing Address - Fax:
Practice Address - Street 1:4612 N 28TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4999
Practice Address - Country:US
Practice Address - Phone:602-764-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261090163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool