Provider Demographics
NPI:1700456217
Name:TRUKSA, SHAMUS MASON (RN)
Entity Type:Individual
Prefix:MR
First Name:SHAMUS
Middle Name:MASON
Last Name:TRUKSA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4815 WESTGROVE DR APT 712
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-6109
Mailing Address - Country:US
Mailing Address - Phone:281-299-7629
Mailing Address - Fax:
Practice Address - Street 1:2831 E PRESIDENT GEORGE BUSH HWY
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-3561
Practice Address - Country:US
Practice Address - Phone:281-299-7629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1037431163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse