Provider Demographics
NPI:1760846687
Name:CHRISTIAN, SHONNA MARIE (NMD)
Entity Type:Individual
Prefix:DR
First Name:SHONNA
Middle Name:MARIE
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 N DOBSON RD STE 20
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-8594
Mailing Address - Country:US
Mailing Address - Phone:480-361-5108
Mailing Address - Fax:
Practice Address - Street 1:15447 N 2ND PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-3048
Practice Address - Country:US
Practice Address - Phone:928-853-3413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16-1538207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine