Provider Demographics
NPI:1790024354
Name:RODENBAUGH, SHAWNA O'NEIL (CRNA)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:O'NEIL
Last Name:RODENBAUGH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SHAWNA
Other - Middle Name:HELENE
Other - Last Name:O'NEIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3689 ASHFORD CREEK TRL NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-5055
Mailing Address - Country:US
Mailing Address - Phone:706-244-1689
Mailing Address - Fax:
Practice Address - Street 1:1740 HUDSON BRIDGE RD STE 1218
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6331
Practice Address - Country:US
Practice Address - Phone:678-604-1053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN170135367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered