Provider Demographics
NPI:1376718627
Name:MCCOSH, SHAUNA MICHELLE (CFNP, CNM)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:MICHELLE
Last Name:MCCOSH
Suffix:
Gender:F
Credentials:CFNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 N RIDGE LOOP DR
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-7243
Mailing Address - Country:US
Mailing Address - Phone:575-574-7911
Mailing Address - Fax:575-388-4514
Practice Address - Street 1:3201 N RIDGE LOOP DR
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7243
Practice Address - Country:US
Practice Address - Phone:575-388-4251
Practice Address - Fax:575-388-4514
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM588367A00000X
NMCNP01356363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000S6635Medicaid
QMP000004444002OtherMOLINA ID
NM300551Medicare PIN