Healthcare Provider Details

I. General information

NPI: 1144521758
Provider Name (Legal Business Name): KAREN SHIELDS MAYO FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2010
Last Update Date: 11/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10535 HOSPITAL WAY VA MEDICAL CENTER - HEMATOLOGY/ONCOLOGY
MATHER CA
95655
US

IV. Provider business mailing address

10535 HOSPITAL WAY VA MEDICAL CENTER - HEMATOLOGY/ONCOLOGY
MATHER CA
95655
US

V. Phone/Fax

Practice location:
  • Phone: 916-843-7008
  • Fax: 916-843-7088
Mailing address:
  • Phone: 916-843-7008
  • Fax: 916-843-7088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License NumberRN426218
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP20347
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: