Provider Demographics
NPI:1982750253
Name:SHIREY, PHILIP STEPHEN (RN NP)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:STEPHEN
Last Name:SHIREY
Suffix:
Gender:M
Credentials:RN NP
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1166 K ST
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-2737
Mailing Address - Country:US
Mailing Address - Phone:760-344-9951
Mailing Address - Fax:
Practice Address - Street 1:651 WAKE AVE
Practice Address - Street 2:STE. 4
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-9490
Practice Address - Country:US
Practice Address - Phone:760-352-2257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CARN247365363LA2200X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health