Provider Demographics
NPI:1619532546
Name:NELSON, SHAUNA ANN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SHAUNA
Middle Name:ANN
Last Name:NELSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:SHAUNA
Other - Middle Name:ANN
Other - Last Name:VAN LEUVEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:886 S PONDEROSA ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-3431
Mailing Address - Country:US
Mailing Address - Phone:949-933-6171
Mailing Address - Fax:
Practice Address - Street 1:886 S PONDEROSA ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-3431
Practice Address - Country:US
Practice Address - Phone:949-933-6171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95011412363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner