Healthcare Provider Details

I. General information

NPI: 1558246181
Provider Name (Legal Business Name): SHANNYN BROOKE WERRA CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 08/11/2025
Certification Date: 08/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5605 W EUGIE AVE STE 102
GLENDALE AZ
85304-1273
US

IV. Provider business mailing address

5605 W EUGIE AVE STE 102
GLENDALE AZ
85304-1273
US

V. Phone/Fax

Practice location:
  • Phone: 602-298-8977
  • Fax:
Mailing address:
  • Phone: 602-298-8977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number306343
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberCNM10231
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: