Provider Demographics
NPI:1427043496
Name:BINETTE, SHAUNA L (ANP)
Entity Type:Individual
Prefix:MS
First Name:SHAUNA
Middle Name:L
Last Name:BINETTE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:MS
Other - First Name:SHAUNA
Other - Middle Name:L
Other - Last Name:WALPOLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:3707 N 7TH ST
Mailing Address - Street 2:#305
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-5059
Mailing Address - Country:US
Mailing Address - Phone:602-264-9100
Mailing Address - Fax:602-264-9101
Practice Address - Street 1:6020 E ARBOR AVE
Practice Address - Street 2:#101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-6102
Practice Address - Country:US
Practice Address - Phone:480-985-1700
Practice Address - Fax:480-396-3659
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN088438363LA2200X
AZAP1734363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ120390OtherGROUP MEDICARE NUMBER
AZ317047OtherGROUP MEDICAID NUMBER
AZWCKKFMedicare ID - Type Unspecified
AZ77730Medicare UPIN
AZ121034Medicare PIN