Healthcare Provider Details

I. General information

NPI: 1740446012
Provider Name (Legal Business Name): MRS. SHARI ANNE WARDLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2008
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5256 MISSION BLVD
RIVERSIDE CA
92509-4624
US

IV. Provider business mailing address

5256 MISSION BLVD
RIVERSIDE CA
92509-4624
US

V. Phone/Fax

Practice location:
  • Phone: 951-955-5327
  • Fax: 951-955-5329
Mailing address:
  • Phone: 951-955-5327
  • Fax: 951-955-5329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number603881
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: