MEDICARE: NINA SHUMIATCHER

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	95009904	CA

General Provider Information

NPI Number	:	1851875918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NINA SHUMIATCHER

Provider Business Mailing Address
First Line	:	259 N ALMONT DR
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-1615
Country	:	US
Telephone Number	:	310-897-5877
Fax Number	:

Provider Business Practice Location Address
First Line	:	1057 KINGSTON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-1310
Country	:	US
Telephone Number	:	800-230-7526
Fax Number	:

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

Provider Enumeration Date	:	09/24/2018
Last Update Date	:	09/24/2018

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Directions to “ NINA SHUMIATCHER ” Practice Location

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