Provider Demographics
NPI:1609147156
Name:MOWERY, SHANA MARIE (RN)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:MARIE
Last Name:MOWERY
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 1:5025 E PACIFIC COAST HWY
Mailing Address - Street 2:#P102
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-3253
Mailing Address - Country:US
Mailing Address - Phone:608-354-1073
Mailing Address - Fax:
Practice Address - Street 1:1045 N LAKE AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-4521
Practice Address - Country:US
Practice Address - Phone:626-794-0706
Practice Address - Fax:626-794-2533
Is Sole Proprietor?:No
Enumeration Date:2012-01-14
Last Update Date:2012-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA784104163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse