Provider Demographics
NPI:1063847937
Name:WALLS, SHAVONNE MONA' (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:SHAVONNE
Middle Name:MONA'
Last Name:WALLS
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 1/2 ARNOULD BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-6213
Mailing Address - Country:US
Mailing Address - Phone:133-753-4442
Mailing Address - Fax:
Practice Address - Street 1:119 1/2 ARNOULD BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-6213
Practice Address - Country:US
Practice Address - Phone:133-753-4442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07318363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily