Healthcare Provider Details

I. General information

NPI: 1528331063
Provider Name (Legal Business Name): SHELLEY R WILLIAMS RN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHELLEY R SHOCKLEY RN

II. Dates (important events)

Enumeration Date: 02/14/2012
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 W CHARLESTON BLVD SUITE 200
LAS VEGAS NV
89102-2351
US

IV. Provider business mailing address

1707 W CHARLESTON BLVD #200
LAS VEGAS NV
89102-2351
US

V. Phone/Fax

Practice location:
  • Phone: 702-671-6469
  • Fax: 702-671-5090
Mailing address:
  • Phone: 702-671-6469
  • Fax: 702-671-5090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN31640
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: