Provider Demographics
NPI:1689099640
Name:NEWBURN, SHAWNETTA FRANCES
Entity Type:Individual
Prefix:
First Name:SHAWNETTA
Middle Name:FRANCES
Last Name:NEWBURN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1146 GRASS POND PL UNIT 103
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-9462
Mailing Address - Country:US
Mailing Address - Phone:702-788-2015
Mailing Address - Fax:
Practice Address - Street 1:1146 GRASS POND PL UNIT 103
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89002-9462
Practice Address - Country:US
Practice Address - Phone:702-788-2015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-28
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV376K00000X376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide