Provider Demographics
NPI:1841572815
Name:PORUMB, SHAWNA LOUISE (RN)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:LOUISE
Last Name:PORUMB
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8040 W YUKON DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-5425
Mailing Address - Country:US
Mailing Address - Phone:602-334-3204
Mailing Address - Fax:
Practice Address - Street 1:21258 NORTH 81ST AVE.
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-4414
Practice Address - Country:US
Practice Address - Phone:623-412-4907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN106439163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse