Provider Demographics
NPI:1811434020
Name:BLANQUIE, SHAUNA M (ATC)
Entity type:Individual
Prefix:MRS
First Name:SHAUNA
Middle Name:M
Last Name:BLANQUIE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4539 HARBOR LN
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-1863
Mailing Address - Country:US
Mailing Address - Phone:707-695-7484
Mailing Address - Fax:
Practice Address - Street 1:4539 HARBOR LN
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-1863
Practice Address - Country:US
Practice Address - Phone:707-695-7484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0305021622255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer