Provider Demographics
NPI:1316066574
Name:SHEWRY, MARCI ANN (NP)
Entity type:Individual
Prefix:
First Name:MARCI
Middle Name:ANN
Last Name:SHEWRY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13354 KIBBINGS RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-1233
Mailing Address - Country:US
Mailing Address - Phone:858-792-2641
Mailing Address - Fax:
Practice Address - Street 1:2626 EL CAMINO REAL STE B
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1253
Practice Address - Country:US
Practice Address - Phone:760-729-2351
Practice Address - Fax:760-729-9675
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB337669363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWNP7069DMedicare UPIN