Provider Demographics
NPI:1164510970
Name:CHRISMAN, SHAWNA SUNGAE (NP,RN,MS,ACNP)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:SUNGAE
Last Name:CHRISMAN
Suffix:
Gender:F
Credentials:NP,RN,MS,ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 GIBSON DR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-5791
Mailing Address - Country:US
Mailing Address - Phone:916-771-2871
Mailing Address - Fax:
Practice Address - Street 1:504 GIBSON DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-5791
Practice Address - Country:US
Practice Address - Phone:916-771-2871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13574363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ06555ZMedicare PIN