Individual
DELIA R SHANAHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
25828 REDLANDS BLVD STE 102, REDLANDS, CA 92373-8451
(909) 558-6600
Mailing address
FILE # 54701, LOS ANGELES, CA 90074-4701
(909) 651-4300
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
10117
WI
363LF0000X
Family Nurse Practitioner
078207-23
NH
363LF0000X
Family Nurse Practitioner
Primary
95023361
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100149140
—
WI
05
—
1033706
—
VT
05
—
3113951
—
NH
Enumeration date
05/15/2017
Last updated
01/19/2023
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