Healthcare Provider Details

I. General information

NPI: 1558015180
Provider Name (Legal Business Name): SHANNON ARTHUR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON DICKELMAN FNP

II. Dates (important events)

Enumeration Date: 02/11/2022
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41540 WINCHESTER RD
TEMECULA CA
92590-4877
US

IV. Provider business mailing address

41540 WINCHESTER RD
TEMECULA CA
92590-4877
US

V. Phone/Fax

Practice location:
  • Phone: 951-365-5585
  • Fax: 951-404-7074
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR38196
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95032229
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: