Individual provider Active NPI

Marilyn Ray Shimel, RN

  • General Practice Registered Nurse
  • Apple Valley, CA
National Provider Identifier
1669518353
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice Registered NurseTaxonomy code 163WG0000X
License
503540 Issued in CA
Practice address
14986 Mandan Rd
Apple Valley, CA 92307-5042
Phone
(760) 242-8864
NPI assigned
Jan 29, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Registered Nurse 163WG0000X 503540 CA Primary

Addresses

Primary practice location

14986 Mandan Rd
Apple Valley, CA 92307-5042

Mailing address

14986 Mandan Rd.
Apple Valley, CA 92307
Phone (760) 242-8864

Other identifiers 1

IdentifierTypeStateIssuer
EPS014460MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
503540CAMDGeneral Practice Registered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1669518353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14986 MANDAN RD.",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "92307",
            "telephone_number": "760-242-8864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14986 MANDAN RD",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923075042",
            "telephone_number": "760-242-8864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIMEL",
        "first_name": "MARILYN",
        "middle_name": "RAY",
        "name_prefix": "Mrs.",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-29",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "CA",
            "license": "503540",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "EPS014460",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Apple Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.