MEDICARE: LORENE ANN SHELBY RNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	16951	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	523806	OTHER	CA	RN

General Provider Information

NPI Number	:	1053525766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORENE ANN SHELBY RNP

Provider Business Mailing Address
First Line	:	1748 E. 118 ST.
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90059
Country	:	US
Telephone Number	:	323-568-3305
Fax Number	:

Provider Business Practice Location Address
First Line	:	1748 E 118TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90059-2518
Country	:	US
Telephone Number	:	323-568-3305
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	11/29/2012

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