Provider Demographics
NPI:1538708284
Name:SHUTT, ANDREA MARIE (LM)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:SHUTT
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34279 DEVLIN DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-7438
Mailing Address - Country:US
Mailing Address - Phone:951-923-3535
Mailing Address - Fax:
Practice Address - Street 1:34279 DEVLIN DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-7438
Practice Address - Country:US
Practice Address - Phone:951-923-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-29
Last Update Date:2019-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM589176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty