Provider Demographics
NPI:1518565654
Name:SHUL, ELVA GISSELLE (LVN)
Entity type:Individual
Prefix:
First Name:ELVA
Middle Name:GISSELLE
Last Name:SHUL
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45001 ALTISSIMO WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92532-1522
Mailing Address - Country:US
Mailing Address - Phone:562-325-3979
Mailing Address - Fax:
Practice Address - Street 1:40700 CALIFORNIA OAKS RD
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5795
Practice Address - Country:US
Practice Address - Phone:951-894-5072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA700691164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse