Provider Demographics
NPI:1235313750
Name:SHIPLEY, SANDRA KAY (RNP)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:KAY
Last Name:SHIPLEY
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3637 ARLINGTON AVE # E202
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3923
Mailing Address - Country:US
Mailing Address - Phone:951-683-4675
Mailing Address - Fax:951-683-1148
Practice Address - Street 1:3637 ARLINGTON AVE # E202
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3923
Practice Address - Country:US
Practice Address - Phone:951-683-4675
Practice Address - Fax:951-683-1148
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8248363LW0102X, 363LX0001X
CA8242363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA363735OtherBOARD OF REGISTERED NURSI