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General NPI Number Information
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NPI Number | 1720855141
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY & SKIN CARE BY SHELLY
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Dates
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Enumeration Date | 12/06/2023
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Last Update Date | 07/18/2024
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Provider Practice Location Address
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Address Line | 1598 SUSAN A WILLIAMS WAY SUITE E
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City | CHINO VALLEY
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State | AZ
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Zip | 86323-5957
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Country | US
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Telephone | 928-499-2915
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Fax | 877-406-3180
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Provider Business Mailing Address
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Address Line | PMB PO BOX 416 1042 WILLOW CREEK RD SUITE A101
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City | PRESCOTT
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State | AZ
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Zip | 86301
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Country | US
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Telephone | 928-899-4455
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Fax |
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Authorized Official
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Title or Position | PROVIDER/OWNER
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Name | SHELLY LYNN CROSSMAN
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Credential | FNP-C, DCNP
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Telephone | 928-499-2915
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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