Provider Demographics
NPI:1790742997
Name:NESSEN, SHAWN C (DO)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:C
Last Name:NESSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1701 W CHARLESTON BLVD
Mailing Address - Street 2:#215
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2325
Mailing Address - Country:US
Mailing Address - Phone:702-671-2395
Mailing Address - Fax:702-382-5388
Practice Address - Street 1:12709 TOEPPERWEIN RD STE 302
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3260
Practice Address - Country:US
Practice Address - Phone:210-653-9307
Practice Address - Fax:210-653-7014
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXS7106208600000X, 2086S0127X, 2086S0102X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP02587370OtherMCRR
TX417623201Medicaid