Provider Demographics
NPI:1295504439
Name:SEGERDAHL, SHAUNA MARIE (WHNP)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:MARIE
Last Name:SEGERDAHL
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:SHAUNA
Other - Middle Name:MARIE
Other - Last Name:VERBOORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11209 N TATUM BLVD STE 255
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-6061
Mailing Address - Country:US
Mailing Address - Phone:503-522-9119
Mailing Address - Fax:
Practice Address - Street 1:11209 N TATUM BLVD STE 255
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-6061
Practice Address - Country:US
Practice Address - Phone:503-522-9119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-29
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10028861363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health