Healthcare Provider Details

I. General information

NPI: 1841606449
Provider Name (Legal Business Name): SHANA ELIZABETH SEMMENS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2014
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 E GRANT RD
TUCSON AZ
85712-2805
US

IV. Provider business mailing address

2800 E AJO WAY
TUCSON AZ
85713-6204
US

V. Phone/Fax

Practice location:
  • Phone: 520-324-3771
  • Fax: 520-324-8091
Mailing address:
  • Phone: 520-874-4891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number56920
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: