| Doctor Name: | JENNIFER MICHELLE SHIVELY |
| NPI Number: | 1003165267 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | N.P. |
| License Number: | 20141 |
| Business Practice Address: | 455 S Main St Orange, CA - 928683835 |
| Business Phone Number: | 7142043277 |
| Business Fax Number: | |
| Mailing Address: | 455 S Main St, ORANGE |
| State: | CA |
| Postal Code: | 928683835 |
| Phone Number: | 7142043277 |
| Fax Number: | |
| NPI Enumeration Date: | 09/04/2012 |
| NPI Last Update Date: | 09/04/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0222X |
| License Number: | 20141 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics, Critical Care |
| Taxonomy Definition: | |