Provider Demographics
NPI:1225372733
Name:OBI, SHIJUANA (CRNA)
Entity Type:Individual
Prefix:
First Name:SHIJUANA
Middle Name:
Last Name:OBI
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 1:1445 VIA SAVONA DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3127
Mailing Address - Country:US
Mailing Address - Phone:803-530-6596
Mailing Address - Fax:
Practice Address - Street 1:8851 W SAHARA AVE UNIT 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5865
Practice Address - Country:US
Practice Address - Phone:702-254-1777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-21
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV819264367500000X
SC104798367500000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse