MEDICARE: MARY SUSAN SHRIMPTON RNFA

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	174400000X	Specialist	RN467911	CA

General Provider Information

NPI Number	:	1487655841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY SUSAN SHRIMPTON RNFA

Provider Business Mailing Address
First Line	:	5260 ZINFANDEL LN
Second Line	:
City	:	VALLEJO
State	:	CA
Zip	:	94591-8391
Country	:	US
Telephone Number	:	415-453-3220
Fax Number	:	415-453-3220

Provider Business Practice Location Address
First Line	:	5260 ZINFANDEL LN
Second Line	:
City	:	VALLEJO
State	:	CA
Zip	:	94591-8391
Country	:	US
Telephone Number	:	415-453-3220
Fax Number	:	415-453-3220

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/08/2007

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