Healthcare Provider Details

I. General information

NPI: 1275554107
Provider Name (Legal Business Name): MARY PATRICIA SHAHAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N HIGHLAND AVE
SHERMAN TX
75092-7379
US

IV. Provider business mailing address

119 W HOUSTON ST
SHERMAN TX
75090-5909
US

V. Phone/Fax

Practice location:
  • Phone: 903-870-4530
  • Fax:
Mailing address:
  • Phone: 903-891-7056
  • Fax: 903-813-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number239654
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: