Provider Demographics
NPI:1417401183
Name:EDWIN, SHANA (RN)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:EDWIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 YOUNKER CT
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-7586
Mailing Address - Country:US
Mailing Address - Phone:907-456-1053
Mailing Address - Fax:
Practice Address - Street 1:650 YOUNKER CT
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-7586
Practice Address - Country:US
Practice Address - Phone:907-456-1053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-10
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK15115163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)