Provider Demographics
NPI:1366124745
Name:SHIRVANIAN, ANGELA QUINN (RN)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:QUINN
Last Name:SHIRVANIAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:CHRISTINA
Other - Last Name:SCHMALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2632 WRENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-8583
Mailing Address - Country:US
Mailing Address - Phone:559-696-4005
Mailing Address - Fax:
Practice Address - Street 1:2632 WRENWOOD AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-8583
Practice Address - Country:US
Practice Address - Phone:559-696-4005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022379163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse