Provider Demographics
NPI:1215627708
Name:FLYNN, SHELLEY RENEE (RN)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:RENEE
Last Name:FLYNN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32295 MISSION TRL STE R8 #255
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-2306
Mailing Address - Country:US
Mailing Address - Phone:909-904-2146
Mailing Address - Fax:
Practice Address - Street 1:29229 CENTRAL AVE # 33
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92532-2248
Practice Address - Country:US
Practice Address - Phone:951-268-9023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA568949163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)