Healthcare Provider Details

I. General information

NPI: 1376586362
Provider Name (Legal Business Name): HEIDI O'DAY YEE N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEIDI O'DAY SHULTS NP

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 NELSON AVE
MODESTO CA
95350
US

IV. Provider business mailing address

2160 COLONIAL BLVD
FORT MYERS FL
33907-1410
US

V. Phone/Fax

Practice location:
  • Phone: 209-575-5870
  • Fax: 209-575-5872
Mailing address:
  • Phone: 239-931-7342
  • Fax: 239-931-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number17314-5
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95002267
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: