Individual
SHAYE LARIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
38001 OLD STAGE RD, GUALALA, CA 95445-8543
(707) 412-3176
(855) 538-4796
Mailing address
PO BOX 1074, GUALALA, CA 95445-1074
(208) 954-3525
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
60704
ID
363LP2300X
Primary Care Nurse Practitioner
Primary
95207424
CA
363LP2300X
Primary Care Nurse Practitioner
NP95207424
CA
Other
Enumeration date
03/27/2019
Last updated
10/02/2025
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