Individual
JENNIFER MICHELLE SHIVELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
455 S MAIN ST, ORANGE, CA 92868-3835
(714) 204-3277
Mailing address
455 S MAIN ST, ORANGE, CA 92868-3835
(714) 204-3277
Taxonomy
Speciality
Code
Description
License number
State
363LP0222X
Critical Care Pediatric Nurse Practitioner
Primary
20141
CA
Other
Enumeration date
09/04/2012
Last updated
09/04/2012
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