Healthcare Provider Details

I. General information

NPI: 1114699287
Provider Name (Legal Business Name): SHANA MAY PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANA HOWERTON

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1038 NORTHWEST BLVD
COEUR D ALENE ID
83814-2249
US

IV. Provider business mailing address

PO BOX 1387
HAYDEN ID
83835-1387
US

V. Phone/Fax

Practice location:
  • Phone: 208-620-5210
  • Fax: 844-807-3782
Mailing address:
  • Phone: 208-415-0299
  • Fax: 208-625-2070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number44855
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number70200
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number70200
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: