Provider Demographics
NPI:1639841331
Name:BECENTI, SHAWNADINE KAREN (NP)
Entity Type:Individual
Prefix:
First Name:SHAWNADINE
Middle Name:KAREN
Last Name:BECENTI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 CHURCH ROCK PL
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-4571
Mailing Address - Country:US
Mailing Address - Phone:505-409-3663
Mailing Address - Fax:
Practice Address - Street 1:207 CHURCH ROCK PL
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-4571
Practice Address - Country:US
Practice Address - Phone:505-409-3663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM65106363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily