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NPI Code Detail

MEDICARE: MRS. CAROLYN NMN SHIVELY

MEDICARE: MRS. CAROLYN NMN SHIVELY
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
1167G00000XLicensed Psychiatric Technician13693CA

General Provider Information

NPI Number : 1518025725
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CAROLYN NMN SHIVELY
Provider Business Mailing Address
First Line : 461 YERBA BUENA ST
Second Line :
City : MORRO BAY
State : CA
Zip : 93442-2973
Country : US
Telephone Number : 805-772-6992
Fax Number :
Provider Business Practice Location Address
First Line : 2178 JOHNSON AVE
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-4535
Country : US
Telephone Number : 805-781-4738
Fax Number : 805-781-1232
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. CAROLYN NMN SHIVELY ” Practice Location

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