Healthcare Provider Details

I. General information

NPI: 1225372733
Provider Name (Legal Business Name): SHIJUANA OBI CRNA, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2012
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5365 S DURANGO DR
LAS VEGAS NV
89113-2500
US

IV. Provider business mailing address

1445 VIA SAVONA DR
HENDERSON NV
89052-3127
US

V. Phone/Fax

Practice location:
  • Phone: 702-254-1777
  • Fax:
Mailing address:
  • Phone: 803-530-6596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number819264
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: