Provider Demographics
NPI:1447868013
Name:SHIRTS, MATTHEW (CRNA)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:SHIRTS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6713 E PRINCETON AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-1441
Mailing Address - Country:US
Mailing Address - Phone:408-802-1588
Mailing Address - Fax:
Practice Address - Street 1:6713 E PRINCETON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-1441
Practice Address - Country:US
Practice Address - Phone:408-802-1588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001400367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered