Healthcare Provider Details

I. General information

NPI: 1881903102
Provider Name (Legal Business Name): SHAUNA EVANSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 S. DOBSON RD STE 101
CHANDLER AZ
85224
US

IV. Provider business mailing address

655 S. DOBSON RD STE 101
CHANDLER AZ
85224
US

V. Phone/Fax

Practice location:
  • Phone: 480-459-2555
  • Fax: 480-687-1802
Mailing address:
  • Phone: 480-459-2555
  • Fax: 480-687-1802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP4906
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: