Provider Demographics
NPI:1568025633
Name:STRONG, SHAWN RENNEA
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:RENNEA
Last Name:STRONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13341
Mailing Address - Street 2:
Mailing Address - City:TRAPPER CREEK
Mailing Address - State:AK
Mailing Address - Zip Code:99683-0341
Mailing Address - Country:US
Mailing Address - Phone:907-227-9040
Mailing Address - Fax:
Practice Address - Street 1:3700 PIPER ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4665
Practice Address - Country:US
Practice Address - Phone:907-269-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK26318163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK6853290OtherALASKA DRIVERS LICENSE