Healthcare Provider Details

I. General information

NPI: 1235313750
Provider Name (Legal Business Name): SANDRA KAY SHIPLEY RNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3637 ARLINGTON AVE # E202
RIVERSIDE CA
92506-3923
US

IV. Provider business mailing address

3637 ARLINGTON AVE # E202
RIVERSIDE CA
92506-3923
US

V. Phone/Fax

Practice location:
  • Phone: 951-683-4675
  • Fax: 951-683-1148
Mailing address:
  • Phone: 951-683-4675
  • Fax: 951-683-1148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number8248
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number8248
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number8242
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: