Provider Demographics
NPI:1124112248
Name:MUNOZ, SHALISE RANAE (FNPC)
Entity type:Individual
Prefix:MRS
First Name:SHALISE
Middle Name:RANAE
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:MRS
Other - First Name:SHALISE
Other - Middle Name:RANAE
Other - Last Name:POLLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNPC
Mailing Address - Street 1:1530 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93305-5406
Mailing Address - Country:US
Mailing Address - Phone:661-631-5895
Mailing Address - Fax:661-631-5898
Practice Address - Street 1:609 4TH STREET
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93304
Practice Address - Country:US
Practice Address - Phone:661-631-3205
Practice Address - Fax:661-328-0591
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15075363LF0000X
CA560836163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice