Healthcare Provider Details

I. General information

NPI: 1669033015
Provider Name (Legal Business Name): SHIRLYNN RACQUEL LINDRUM NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5887 BROCKTON AVE STE A
RIVERSIDE CA
92506-1858
US

IV. Provider business mailing address

5887 BROCKTON AVE STE A
RIVERSIDE CA
92506-1858
US

V. Phone/Fax

Practice location:
  • Phone: 951-275-8500
  • Fax: 951-275-8560
Mailing address:
  • Phone: 951-275-8500
  • Fax: 951-275-8560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95033349
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: