Provider Demographics
NPI:1366598633
Name:SHIREY, RITA ALICIA (RN NP)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:ALICIA
Last Name:SHIREY
Suffix:
Gender:F
Credentials:RN NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 628
Mailing Address - Street 2:
Mailing Address - City:SEELEY
Mailing Address - State:CA
Mailing Address - Zip Code:92273-0628
Mailing Address - Country:US
Mailing Address - Phone:760-352-3304
Mailing Address - Fax:
Practice Address - Street 1:651 WAKE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-9490
Practice Address - Country:US
Practice Address - Phone:760-352-2257
Practice Address - Fax:760-352-7853
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CARN257179363LA2200X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology