Healthcare Provider Details

I. General information

NPI: 1679082564
Provider Name (Legal Business Name): SHAYNA GAYLE LABARGE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2017
Last Update Date: 02/24/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1437 W AUTO DR
TEMPE AZ
85284-1016
US

IV. Provider business mailing address

1437 W AUTO DR
TEMPE AZ
85284-1016
US

V. Phone/Fax

Practice location:
  • Phone: 602-362-2983
  • Fax:
Mailing address:
  • Phone: 602-362-2983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number223549
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP09609
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP09609
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number223549
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: