Provider Demographics
NPI:1184076986
Name:JURINA, SHANNAN LEE (RN)
Entity type:Individual
Prefix:MRS
First Name:SHANNAN
Middle Name:LEE
Last Name:JURINA
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 1:3105 MUNTJAC
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-6139
Mailing Address - Country:US
Mailing Address - Phone:913-710-9875
Mailing Address - Fax:
Practice Address - Street 1:3105 MUNTJAC
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-6139
Practice Address - Country:US
Practice Address - Phone:913-710-9875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS108288-072390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program