Healthcare Provider Details

I. General information

NPI: 1891182002
Provider Name (Legal Business Name): SHETERAH BURNETT-WRENN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2015
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2813 S MAIN ST
CORONA CA
92882-5942
US

IV. Provider business mailing address

PO BOX 935
MORENO VALLEY CA
92556-0935
US

V. Phone/Fax

Practice location:
  • Phone: 951-272-5445
  • Fax:
Mailing address:
  • Phone: 951-403-8492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number95038234
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: