MEDICARE: ANDREA CORINNE SHIRLEY NNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WN0002X	Neonatal Intensive Care Registered Nurse	RN60202071	WA
2	163WN0002X	Neonatal Intensive Care Registered Nurse	10022549	OR
3	363LN0000X	Neonatal Nurse Practitioner	6471892	ID

General Provider Information

NPI Number	:	1346101276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA CORINNE SHIRLEY NNP-BC

Provider Business Mailing Address
First Line	:	7806 FREMONT WAY
Second Line	:
City	:	YAKIMA
State	:	WA
Zip	:	98908-2088
Country	:	US
Telephone Number	:	509-823-8391
Fax Number	:

Provider Business Practice Location Address
First Line	:	1055 N CURTIS RD
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83706-1309
Country	:	US
Telephone Number	:	208-367-2121
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2025
Last Update Date	:	03/10/2026

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