Provider Demographics
NPI:1831740125
Name:SOUZA, SHANNAN DEANN (APRN)
Entity type:Individual
Prefix:
First Name:SHANNAN
Middle Name:DEANN
Last Name:SOUZA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150A SR 247
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72858-6002
Mailing Address - Country:US
Mailing Address - Phone:479-567-5679
Mailing Address - Fax:479-567-5680
Practice Address - Street 1:5150A SR 247
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72858-6002
Practice Address - Country:US
Practice Address - Phone:479-567-5679
Practice Address - Fax:479-567-5680
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARF06192213363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily