MEDICARE: KATHY SHADLE JAMES DNSC, NP

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	363LF0000X	Family Nurse Practitioner	302911	CA

General Provider Information

NPI Number	:	1396950135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY SHADLE JAMES DNSC, NP

Provider Business Mailing Address
First Line	:	617 SERPENTINE DR
Second Line	:
City	:	DEL MAR
State	:	CA
Zip	:	92014-2442
Country	:	US
Telephone Number	:	619-890-1244
Fax Number	:	858-259-9375

Provider Business Practice Location Address
First Line	:	1933 CABLE ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92107-2807
Country	:	US
Telephone Number	:	619-221-4490
Fax Number	:

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

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	07/08/2007

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