Provider Demographics
NPI:1982943015
Name:CONCEPCION, SHANE CRISTINA (CNS)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:CRISTINA
Last Name:CONCEPCION
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 W BEN WHITE BLVD STE 100A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7792
Mailing Address - Country:US
Mailing Address - Phone:512-440-5757
Mailing Address - Fax:512-440-5858
Practice Address - Street 1:1221 W BEN WHITE BLVD STE 100A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7792
Practice Address - Country:US
Practice Address - Phone:512-440-5757
Practice Address - Fax:512-440-5858
Is Sole Proprietor?:No
Enumeration Date:2013-02-08
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX792002364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX271022YN72Medicare PIN