Provider Demographics
NPI:1508813908
Name:ZERHUSEN, SHAUNA MARIE (CNM)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:MARIE
Last Name:ZERHUSEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MEDICAL VILLAGE DRIVE SUITE 354
Mailing Address - Street 2:ATTN. BEVERLY MEYER
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017
Mailing Address - Country:US
Mailing Address - Phone:859-331-4665
Mailing Address - Fax:859-331-6370
Practice Address - Street 1:20 MEDICAL VILLAGE DRIVE SUITE 354
Practice Address - Street 2:ATTN. BEVERLY MEYER
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017
Practice Address - Country:US
Practice Address - Phone:859-331-4665
Practice Address - Fax:859-331-6370
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYRN1044608163W00000X
KY3002899363L00000X
KYCNM2899M367A00000X
KY10374367A00000X
OHCOA.04214-NM367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78010543Medicaid
OH2284166Medicaid
KYP00985237OtherRAILROAD MEDICARE
KY3316380Medicare PIN
OH2284166Medicaid
KY78010543Medicaid
KY3396874Medicare PIN
KY0969498Medicare PIN