Provider Demographics
NPI:1801980271
Name:FRONTERHOUSE, SHAWN (PA-C)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:FRONTERHOUSE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8651 FRANZ VALLEY SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:CALISTOGA
Mailing Address - State:CA
Mailing Address - Zip Code:94515-9556
Mailing Address - Country:US
Mailing Address - Phone:505-301-4939
Mailing Address - Fax:
Practice Address - Street 1:821 SAINT HELENA HWY S STE 1
Practice Address - Street 2:
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-2266
Practice Address - Country:US
Practice Address - Phone:707-967-7551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA63776363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000G2346Medicaid
$$$$$$$$$Medicare PIN
P39173Medicare UPIN