Healthcare Provider Details

I. General information

NPI: 1639660483
Provider Name (Legal Business Name): SHELLY LYNN HILL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2018
Last Update Date: 05/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7050 N RECREATION AVE STE 103
FRESNO CA
93720-8001
US

IV. Provider business mailing address

2477 E CHRISTOPHER DR
FRESNO CA
93720-4435
US

V. Phone/Fax

Practice location:
  • Phone: 559-256-7700
  • Fax: 559-256-7711
Mailing address:
  • Phone: 559-434-4063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number473396
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: