Healthcare Provider Details

I. General information

NPI: 1124202460
Provider Name (Legal Business Name): SHELLY RENEE CHAVIRA LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. SHELLY BUTLER

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 G ST KINGSVIEW
FRESNO CA
93706-1643
US

IV. Provider business mailing address

1206 G ST KINGSVIEW HOUSING & RECOVERY
FRESNO CA
93706-1643
US

V. Phone/Fax

Practice location:
  • Phone: 559-459-0334
  • Fax: 559-459-0339
Mailing address:
  • Phone: 559-459-0334
  • Fax: 559-459-0339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number199365
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: