Provider Demographics
NPI:1114069440
Name:SIQUEIROS, SHAWN E (RN, NP)
Entity Type:Individual
Prefix:MS
First Name:SHAWN
Middle Name:E
Last Name:SIQUEIROS
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:SHAWN
Other - Middle Name:
Other - Last Name:SIQUEIROS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3480 E BRITANNIA DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85706-5007
Mailing Address - Country:US
Mailing Address - Phone:520-205-4904
Mailing Address - Fax:
Practice Address - Street 1:3480 E BRITANNIA DR
Practice Address - Street 2:SUITE 120
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85706-5007
Practice Address - Country:US
Practice Address - Phone:520-205-4904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN098814163WS0200X
AZAP5434364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
No163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ613415Medicaid