Healthcare Provider Details

I. General information

NPI: 1043649460
Provider Name (Legal Business Name): MRS. SHIRLEY NANCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHIRLEY MARIE NANCE RN

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 11/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 W MOANA LN SUITE 330
RENO NV
89509-4991
US

IV. Provider business mailing address

745 W MOANA LN SUITE 330
RENO NV
89509-4991
US

V. Phone/Fax

Practice location:
  • Phone: 775-788-7600
  • Fax: 775-788-7611
Mailing address:
  • Phone: 775-788-7600
  • Fax: 775-788-7611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN33305
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: