Provider Demographics
NPI:1083071989
Name:UNSWORTH, SHAYNE (RN)
Entity Type:Individual
Prefix:
First Name:SHAYNE
Middle Name:
Last Name:UNSWORTH
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-1725
Mailing Address - Country:US
Mailing Address - Phone:785-621-4959
Mailing Address - Fax:785-621-4959
Practice Address - Street 1:2900 WILLOW ST
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-1725
Practice Address - Country:US
Practice Address - Phone:785-621-4959
Practice Address - Fax:785-621-4959
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-108859-062163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse