Provider Demographics
NPI:1184041204
Name:MAWYIN, SHANNON (CRNA)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:MAWYIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2052 GLENDALE RD
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-6754
Mailing Address - Country:US
Mailing Address - Phone:314-660-4294
Mailing Address - Fax:
Practice Address - Street 1:520 S SANTA FE AVE
Practice Address - Street 2:260
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-4190
Practice Address - Country:US
Practice Address - Phone:785-827-2238
Practice Address - Fax:785-827-1684
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS557253367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS20109546AMedicaid