Healthcare Provider Details

I. General information

NPI: 1528604709
Provider Name (Legal Business Name): SHELBY ALEXANDRIA COLBURN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2019
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11160 WARNER AVE STE 411
FOUNTAIN VALLEY CA
92708-4056
US

IV. Provider business mailing address

11160 WARNER AVE STE 411
FOUNTAIN VALLEY CA
92708-4056
US

V. Phone/Fax

Practice location:
  • Phone: 714-513-1399
  • Fax: 714-513-1393
Mailing address:
  • Phone: 714-513-1399
  • Fax: 714-513-1393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number95212452
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number1-174014
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number95024839
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: