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NPI Code Detail

MEDICARE: MARYELLEN A SHIMMEL RN, MFT

MEDICARE:   MARYELLEN A SHIMMEL  RN, MFT
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
1101YM0800XMental Health Counselor29276CA
2163W00000XRegistered Nurse225887CA

General Provider Information

NPI Number : 1457374043
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARYELLEN A SHIMMEL RN, MFT
Provider Business Mailing Address
First Line : 6316 PALMBROOK CT
Second Line :
City : BAKERSFIELD
State : CA
Zip : 93306-7490
Country : US
Telephone Number : 661-872-9089
Fax Number : 661-872-9089
Provider Business Practice Location Address
First Line : 5401 BUSINESS PARK S
Second Line : SUITE #100
City : BAKERSFIELD
State : CA
Zip : 93309-0721
Country : US
Telephone Number : 661-703-4787
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2006
Last Update Date : 03/18/2009

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