Provider Demographics
NPI:1861045049
Name:ESCALANTE, SHAUNA RAENELL (RN)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:RAENELL
Last Name:ESCALANTE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SHAUNA
Other - Middle Name:RAENELL
Other - Last Name:HERBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:719 SAN MATEO BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-1434
Mailing Address - Country:US
Mailing Address - Phone:505-485-0464
Mailing Address - Fax:505-266-1017
Practice Address - Street 1:825 S SHIELDS ST STE 6AND7
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-3590
Practice Address - Country:US
Practice Address - Phone:970-493-0281
Practice Address - Fax:970-493-0729
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX756553163W00000X
CORN.1663084163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse