Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 19763 | CA |
NPI | 1255650537 |
---|---|
Provider Name | Ms. Shelly Anne Ferrari |
First Address | Glendora, CA 91741-2124 |
Second Address | Glendora, CA 91741-2124 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2010 |
Last Update Date | 25/05/2010 |