Provider Demographics
NPI:1629504154
Name:APPLEGATE, SHAWNA RENEE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SHAWNA
Middle Name:RENEE
Last Name:APPLEGATE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SHAWNA
Other - Middle Name:RENEE
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:156 BANJO HILL LN
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404
Mailing Address - Country:US
Mailing Address - Phone:406-899-5283
Mailing Address - Fax:406-454-6858
Practice Address - Street 1:115 4TH ST S.
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404
Practice Address - Country:US
Practice Address - Phone:406-454-6973
Practice Address - Fax:406-454-6858
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT125591363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily