Healthcare Provider Details

I. General information

NPI: 1740561331
Provider Name (Legal Business Name): MELANIE ANNE SHOOK RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2011
Last Update Date: 09/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6678 MOUNT WHITNEY AVE
RIVERSIDE CA
92506-3918
US

IV. Provider business mailing address

6678 MOUNT WHITNEY AVE
RIVERSIDE CA
92506-3918
US

V. Phone/Fax

Practice location:
  • Phone: 951-329-0368
  • Fax:
Mailing address:
  • Phone: 951-329-0368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number801886
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: