Healthcare Provider Details

I. General information

NPI: 1558021279
Provider Name (Legal Business Name): VALERIE SHUMATE CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2021
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 ATLANTIC AVE
LONG BEACH CA
90806-2701
US

IV. Provider business mailing address

2701 ATLANTIC AVE
LONG BEACH CA
90806-2701
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-5455
  • Fax: 562-933-8586
Mailing address:
  • Phone: 562-933-5455
  • Fax: 562-933-8586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95013884
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: