Healthcare Provider Details

I. General information

NPI: 1316091622
Provider Name (Legal Business Name): SHIRLEY L FETT CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4282 GENESEE AVE SUITE 103
SAN DIEGO CA
92117-4946
US

IV. Provider business mailing address

8825 AERO DR STE 315
SAN DIEGO CA
92123-2270
US

V. Phone/Fax

Practice location:
  • Phone: 858-292-0108
  • Fax: 858-292-9097
Mailing address:
  • Phone: 858-956-5905
  • Fax: 858-227-2953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number353925
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number353925
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: