Basic Information
| Provider Information | |||||||||
| NPI: | 1700952439 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHINN | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | RN CNS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 560 COHASSET RD STE 175 | ||||||||
| Address2: | |||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959262212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308912784 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 560 COHASSET RD | ||||||||
| Address2: | SUITE 175 | ||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959262212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308912784 | ||||||||
| FaxNumber: | 5308912809 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2006 | ||||||||
| LastUpdateDate: | 04/05/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN213969 | CA | Y | Nursing Service Providers | Registered Nurse | 163WP0809X | RN213969 | CA | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Adult |
ID Information
| ID | Type | State | Issuer | Description | RN213969 | 01 | CA | BRN | OTHER |