Healthcare Provider Details

I. General information

NPI: 1285809871
Provider Name (Legal Business Name): SHAWNA M HENRY CNNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 S 31ST ST
TEMPLE TX
76508-0001
US

IV. Provider business mailing address

2401 S 31ST ST
TEMPLE TX
76508-0001
US

V. Phone/Fax

Practice location:
  • Phone: 254-724-2311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number169374
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: