Provider Demographics
NPI:1972194181
Name:TATUM, SHAWNA LATRICE (BSN, RN, CCM)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:LATRICE
Last Name:TATUM
Suffix:
Gender:F
Credentials:BSN, RN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 MIDDALE RD
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-3229
Mailing Address - Country:US
Mailing Address - Phone:469-992-1031
Mailing Address - Fax:
Practice Address - Street 1:531 MIDDALE RD
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-3229
Practice Address - Country:US
Practice Address - Phone:214-418-9809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-30
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX800769163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse