Provider Demographics
NPI:1437904927
Name:FEJERAN, SHIRAE ANTOINETTE CEPEDA (RN)
Entity Type:Individual
Prefix:MISS
First Name:SHIRAE
Middle Name:ANTOINETTE CEPEDA
Last Name:FEJERAN
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 1:498 CHALAN PALASYO
Mailing Address - Street 2:
Mailing Address - City:AGANA HEIGHTS
Mailing Address - State:GU
Mailing Address - Zip Code:96910
Mailing Address - Country:US
Mailing Address - Phone:671-475-5760
Mailing Address - Fax:
Practice Address - Street 1:498 CHALAN PALASYO
Practice Address - Street 2:
Practice Address - City:AGANA HEIGHTS
Practice Address - State:GU
Practice Address - Zip Code:96910
Practice Address - Country:US
Practice Address - Phone:671-475-5760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GURX0903163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse