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Individual

ELIZABETH SHALLENBERGER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
1510 SAN PABL STREET, LOS ANGELES, CA 90033-5320
(323) 442-5907
(323) 442-6020
Mailing address
PO BOX 31309, LOS ANGELES, CA 90031-0309
(323) 865-1241

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
16796
CA
363LG0600X
Gerontology Nurse Practitioner
213285
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0390071
MA
01
NP2988
BLUE CROSS BLUE SHIELD
MA
Enumeration date
09/13/2006
Last updated
04/17/2015
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