Provider Demographics
NPI:1972373298
Name:HATCHITT, SHAUNA RAE (ARNP)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:RAE
Last Name:HATCHITT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4216 PORTER ADDITION
Mailing Address - Street 2:
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-8143
Mailing Address - Country:US
Mailing Address - Phone:641-758-0290
Mailing Address - Fax:
Practice Address - Street 1:520 11TH ST NW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52405-3835
Practice Address - Country:US
Practice Address - Phone:319-398-3562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG177304363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health