Provider Demographics
NPI:1679957609
Name:EDWARDS, SHAUN REBECCA (APRN)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:REBECCA
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SHAUN
Other - Middle Name:REBECCA
Other - Last Name:MCCORMICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:530 DEMOSS ST.
Mailing Address - Street 2:
Mailing Address - City:LORDSBURG
Mailing Address - State:NM
Mailing Address - Zip Code:88045
Mailing Address - Country:US
Mailing Address - Phone:575-542-2369
Mailing Address - Fax:575-542-2388
Practice Address - Street 1:550 E WASHINGTON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-8161
Practice Address - Country:US
Practice Address - Phone:707-465-6925
Practice Address - Fax:707-387-9808
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK79150363LP2300X
NM69797363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care