Provider Demographics
NPI:1528331063
Name:WILLIAMS, SHELLEY R (RN, CDE)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:R
Other - Last Name:SHOCKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1707 W CHARLESTON BLVD
Mailing Address - Street 2:#200
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2351
Mailing Address - Country:US
Mailing Address - Phone:702-671-6469
Mailing Address - Fax:702-671-5090
Practice Address - Street 1:1707 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2351
Practice Address - Country:US
Practice Address - Phone:702-671-6469
Practice Address - Fax:702-671-5090
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN31640163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
20910538OtherCERTIFIED DIABETES EDUCATOR