Provider Demographics
NPI:1225129364
Name:BOHNE, SHAREN (RN CPNP)
Entity Type:Individual
Prefix:
First Name:SHAREN
Middle Name:
Last Name:BOHNE
Suffix:
Gender:F
Credentials:RN CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4137 N 108TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-5459
Mailing Address - Country:US
Mailing Address - Phone:623-877-7337
Mailing Address - Fax:
Practice Address - Street 1:4137 N 108TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-5459
Practice Address - Country:US
Practice Address - Phone:623-877-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ125608363LP0200X
AZAP2080363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ935661Medicaid
AZ935661Medicaid
AZQ68749Medicare UPIN