Provider Demographics
NPI:1144702291
Name:SHIMAN, JEANETTE LYNN
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:LYNN
Last Name:SHIMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 E MILL AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3808
Mailing Address - Country:US
Mailing Address - Phone:559-853-6222
Mailing Address - Fax:559-993-2101
Practice Address - Street 1:89 E MILL AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3808
Practice Address - Country:US
Practice Address - Phone:559-853-6222
Practice Address - Fax:559-993-2101
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1679921241Medicaid