Provider Demographics
NPI:1316091622
Name:FETT, SHIRLEY L (CFNP)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:L
Last Name:FETT
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8825 AERO DR STE 315
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2270
Mailing Address - Country:US
Mailing Address - Phone:858-956-5905
Mailing Address - Fax:858-227-2953
Practice Address - Street 1:4282 GENESEE AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-4946
Practice Address - Country:US
Practice Address - Phone:858-292-0108
Practice Address - Fax:858-292-9097
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA353925363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health