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General NPI Number Information
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NPI Number | 1134526270
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Entity Type | Individual
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Provider Name | SHAWN MICHELLE LAIRD RN, NP
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Gender | Female
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Dates
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Enumeration Date | 12/03/2014
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Last Update Date | 04/09/2019
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Provider Practice Location Address
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Address Line | 15615 POMERADO RD
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City | POWAY
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State | CA
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Zip | 92064-2405
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Country | US
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Telephone | 858-613-4187
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Fax | 858-613-4262
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Provider Business Mailing Address
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Address Line | 2406 MCDOUGAL PL
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City | ALPINE
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State | CA
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Zip | 91901-1407
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Country | US
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Telephone | 619-659-8493
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 95001797
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License Number State | CA
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