MRS. SHELLY REBECCA LUMMUS (NPI# 1649474545) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649474545 |
| Entity Type | Individual |
| Full Name | MRS. SHELLY REBECCA LUMMUS |
| Credential | FNP |
| Practice Address |
3505 Cadillac Ave Building O Suite 110 Costa Mesa CA 92626-1429 |
| Mailing Address |
5225 Tedford Way Yorba Linda CA 92886-4122 |
| Practice Telephone | 7147551160 |
| Mailing Telephone | 7143312034 |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
417062 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | REGISTERD NURSE NUMBER | RN 417062 | 01 |
| CA | NURSE PRACTITIONER CERTIF | 9198 | 01 |
| DEA CERTIFICATE | ML0499904 | 01 |
| Street Address |
3505 CADILLAC AVE BUILDING O SUITE 110 |
| City | COSTA MESA |
| State | CA |
| Zip Code | 92626-1429 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760428072 | Therese Louise Wright | Nurse Practitioner | 3505 Cadillac Ave, Costa Mesa, CA 92626-1429 | 2006-06-22 |
| 1366984213 | Pathways To Wellness | Community/Behavioral Health | 3505 Cadillac Ave, Building O, Suite 109, Costa Mesa, CA 92626-1429 | 2016-11-09 |
| 1710257936 | Stephenie R Champlin | Social Worker | 3505 Cadillac Ave, Bldg O, Suite 109, Costa Mesa, CA 92626-1429 | 2012-01-04 |
| 1538452297 | Marshall B. Stamper | Family Medicine | 3505 Cadillac Ave, Costa Mesa, CA 92626-1429 | 2011-05-27 |
| 1518158831 | Mary Jane Pageau | Nurse Practitioner | 3505 Cadillac Ave, Bldg O, Suite 110, Costa Mesa, CA 92626-1429 | 2007-08-05 |
| 1255539912 | Carolyn D Gale | Dietary Manager | 3505 Cadillac Ave, Suite N-2, Costa Mesa, CA 92626-1429 | 2007-07-04 |
| 1205862224 | Nancy D Young | Psychologist | 3505 Cadillac Ave, Bldg O, Suite 109, Costa Mesa, CA 92626-1429 | 2006-06-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215536982 | Sergio Gutierrez | Behavior Technician | 3303 Harbor Blvd., Suite B8, Costa Mesa, CA 92626 | 2020-10-22 |
| 1780201848 | Kelly Chauvet | Behavior Technician | 1503 Nutmeg Place Suite 110, Costa Mesa, CA 92626 | 2020-07-06 |
| 1316564610 | Timo Rosa | Behavior Technician | 1503 Nutmeg Place, Suite 110, Costa Mesa, CA 92626 | 2020-07-02 |
| 1255966115 | Dalia A Sehweil | Behavior Technician | 1111 Baker, Costa Mesa, CA 92626 | 2020-03-11 |
| 1265071096 | Austin Stotelmyre | Behavior Technician | 1111 Baker St Costa Mesa 92626, Costa Mesa, CA 92626 | 2019-12-26 |
| 1396383022 | The Open Table | Community/Behavioral Health | 151 Kalmus Dr. Bldg C, Suite 100, Costa Mesa, CA 92626 | 2019-12-12 |
| 1851933550 | Jennifer Rivera | Behavior Technician | 1111 Baker St. Unit #a, Costa Mesa, CA 92626 | 2019-10-14 |
| 1962053595 | Peter Na | Behavior Technician | Behavior Functions 3303 Harbor Blvd, Ste B8, Costa Mesa, CA 92626 | 2019-09-25 |
| 1346897147 | Jennifer Lopez | Behavior Technician | 555 Alton Blvd Suite 150, Costa Mesa, CA 92626 | 2019-08-26 |
| 1679134084 | Danny Garcia Chiropractic, PC | Chiropractor | 1503 South Coast Drive, Suite 319, Costa Mesa, CA 92626 | 2019-06-26 |
| Find all providers in zip 92626 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811546872 | Brett Ashley Hartsfield | Nurse Practitioner | 485 E 17th St Ste 500, Costa Mesa, CA 92627-4705 | 2019-09-11 |
| 1558894741 | Lai Man Wong | Nurse Practitioner | 150 Paularino Ave Bld D Suite 182, Costa Mesa, CA 92626 | 2017-04-05 |
| 1720520182 | Andrea Beyaoju | Nurse Practitioner | 771 Allegheny Ave, Costa Mesa, CA 92626-3002 | 2016-11-15 |
| 1518417633 | Arnold Franco | Nurse Practitioner | 3360 Via Trentino, Costa Mesa, CA 92626-1691 | 2016-10-12 |
| 1609324524 | Angela Ciano | Nurse Practitioner | 2306 Elden Ave, Apt C, Costa Mesa, CA 92627-6504 | 2016-09-20 |
| 1972960078 | Sandra Lynn Gordon-bitar | Nurse Practitioner | 2975 Redhill Avenue, Suite 175, Costa Mesa, CA 92626 | 2016-01-20 |
| 1194005975 | Laura Conahan | Nurse Practitioner | 2200 Harbor Blvd Suite B210, Costa Mesa, CA 92627 | 2011-08-24 |
| 1245519172 | Patricia Thalken Lash | Nurse Practitioner | 1190 Baker Street, 100, Costa Mesa, CA 92659 | 2011-08-09 |
| 1831428028 | Claudene Koros Stark | Nurse Practitioner | 1150 Baker Street, Minute Clinic, Costa Mesa, CA 92626 | 2009-12-17 |
| 1629101589 | Nicole Herriott | Nurse Practitioner | 2569 Orange Ave Apt J, Costa Mesa, CA 92627-5119 | 2007-03-13 |
| Find all providers in COSTA MESA | ||||
| City | COSTA MESA |
| Zip Code | 92626 |
Please comment or provide details below to improve the information on MRS. SHELLY REBECCA LUMMUS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.