Healthcare Provider Details

I. General information

NPI: 1356516520
Provider Name (Legal Business Name): SHELLY COUNTS R.N., BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71780 SAN JACINTO DR SUITE B3
RANCHO MIRAGE CA
92270-5516
US

IV. Provider business mailing address

71780 SAN JACINTO DR SUITE B3
RANCHO MIRAGE CA
92270-5516
US

V. Phone/Fax

Practice location:
  • Phone: 760-341-3501
  • Fax: 760-341-3099
Mailing address:
  • Phone: 760-341-3501
  • Fax: 760-341-3099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number597391
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: