Healthcare Provider Details

I. General information

NPI: 1912495532
Provider Name (Legal Business Name): SHAWN ALEXANDER HENRY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SHAWN SCHOONVELD

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 SAINT VINCENT CIR
LITTLE ROCK AR
72205-5423
US

IV. Provider business mailing address

7028 FIELDS DR
ALEXANDER AR
72002-8075
US

V. Phone/Fax

Practice location:
  • Phone: 501-552-3000
  • Fax:
Mailing address:
  • Phone: 501-765-4269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberC003243
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: