Provider Demographics
NPI:1518745140
Name:BIGBY, SHAUNA GORHAM (DNP)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:GORHAM
Last Name:BIGBY
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-1885
Mailing Address - Country:US
Mailing Address - Phone:626-914-8671
Mailing Address - Fax:
Practice Address - Street 1:10808 FOOTHILL BLVD STE 160-219
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3889
Practice Address - Country:US
Practice Address - Phone:626-283-5888
Practice Address - Fax:626-283-5855
Is Sole Proprietor?:No
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA532248363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily