Provider Demographics
NPI:1124215579
Name:NELSON, SHAUNA (RN)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 N 420 E
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:UT
Mailing Address - Zip Code:84624-9176
Mailing Address - Country:US
Mailing Address - Phone:435-864-3612
Mailing Address - Fax:435-864-3612
Practice Address - Street 1:428 EAST TOPAZ BLVD #D
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:UT
Practice Address - Zip Code:84624
Practice Address - Country:US
Practice Address - Phone:435-864-3612
Practice Address - Fax:435-864-3612
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6213294-3102163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health