Provider Demographics
NPI:1407158090
Name:UNDERWOOD, SHAWNA RAE (FNP-C)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:RAE
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 W BELL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-3059
Mailing Address - Country:US
Mailing Address - Phone:602-680-2386
Mailing Address - Fax:
Practice Address - Street 1:2727 W BELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-3059
Practice Address - Country:US
Practice Address - Phone:602-680-2386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3843261QP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care