Provider Demographics
NPI:1255073029
Name:WIDNEY, SHANNON ROCHELE (BSN RN)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:ROCHELE
Last Name:WIDNEY
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30898 N 126TH DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-5042
Mailing Address - Country:US
Mailing Address - Phone:602-570-7843
Mailing Address - Fax:
Practice Address - Street 1:10851 W WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85373-3375
Practice Address - Country:US
Practice Address - Phone:623-412-5279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN160688163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool