Provider Demographics
NPI:1588964159
Name:NURSE PRACTITIONERS OF CALIFORNIA
Entity type:Organization
Organization Name:NURSE PRACTITIONERS OF CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:951-852-8505
Mailing Address - Street 1:26025 NEWPORT ROAD
Mailing Address - Street 2:SUITE A 305
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584
Mailing Address - Country:UM
Mailing Address - Phone:951-852-8505
Mailing Address - Fax:951-746-3496
Practice Address - Street 1:25105 CLOVER CREEK LN
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-8456
Practice Address - Country:US
Practice Address - Phone:951-852-8505
Practice Address - Fax:951-746-3496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18946363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty