Provider Demographics
NPI:1447770698
Name:MCGEE, SHAWN M (CNP)
Entity Type:Individual
Prefix:MS
First Name:SHAWN
Middle Name:M
Last Name:MCGEE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 B VETERANS BLVD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO OF ACOMA
Mailing Address - State:NM
Mailing Address - Zip Code:87034
Mailing Address - Country:US
Mailing Address - Phone:505-552-5300
Mailing Address - Fax:505-552-5490
Practice Address - Street 1:12127B HWY 14 N STE 5
Practice Address - Street 2:
Practice Address - City:CEDAR CREST
Practice Address - State:NM
Practice Address - Zip Code:87008-9499
Practice Address - Country:US
Practice Address - Phone:505-350-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP03253363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMH3451Medicaid