Provider Demographics
NPI:1841731304
Name:WARD, SHAWNA RAE (CRNP)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:RAE
Last Name:WARD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1671 W INA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1910
Mailing Address - Country:US
Mailing Address - Phone:520-797-8555
Mailing Address - Fax:877-409-3138
Practice Address - Street 1:1671 W INA RD STE 101
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1910
Practice Address - Country:US
Practice Address - Phone:520-797-8555
Practice Address - Fax:877-409-3138
Is Sole Proprietor?:No
Enumeration Date:2017-03-17
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ274231363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner