Healthcare Provider Details

I. General information

NPI: 1811431455
Provider Name (Legal Business Name): SHIRLEY HUFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2016
Last Update Date: 12/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 INDEPENDENCE CIR
CHICO CA
95973-0258
US

IV. Provider business mailing address

100 INDEPENDENCE CIR
CHICO CA
95973-0258
US

V. Phone/Fax

Practice location:
  • Phone: 530-899-2107
  • Fax:
Mailing address:
  • Phone: 530-899-2107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number53681
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: