Provider Demographics
NPI:1053470963
Name:BARBEAU, SHAUNA LEE (MSN CNP)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:LEE
Last Name:BARBEAU
Suffix:
Gender:F
Credentials:MSN CNP
Other - Prefix:
Other - First Name:SHAUNA
Other - Middle Name:LEE
Other - Last Name:DOOLITTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN CNP
Mailing Address - Street 1:501 LAPEER
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48607-1208
Mailing Address - Country:US
Mailing Address - Phone:989-759-6464
Mailing Address - Fax:989-399-8233
Practice Address - Street 1:1522 JANES ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-1819
Practice Address - Country:US
Practice Address - Phone:989-755-0316
Practice Address - Fax:989-755-0956
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704252799363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI500G310570OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI1053470963Medicaid
MI157557OtherGREAT LAKES HEALTH PLAN OF MICHIGAN
MI1026128OtherMCLAREN HEALTH PLAN
MI1053470963OtherMOLINA HEALTHCARE OF MICHIGAN
Q74488Medicare UPIN
MI1053470963Medicaid