Healthcare Provider Details

I. General information

NPI: 1982192423
Provider Name (Legal Business Name): SHIRRELLE MARIA EVERETT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S 7TH AVE STE B&C
BARSTOW CA
92311-3056
US

IV. Provider business mailing address

1720 N FULLER AVE APT 247
LOS ANGELES CA
90046-3075
US

V. Phone/Fax

Practice location:
  • Phone: 760-256-1777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024175662
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95009257
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: