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General NPI Number Information
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NPI Number | 1265297097
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Entity Type | Individual
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Provider Name | SHAUN CHRISTIAN JAVA
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Gender | Male
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Dates
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Enumeration Date | 02/20/2024
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Last Update Date | 06/07/2024
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Provider Practice Location Address
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Address Line | 19829 N 27TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85027-4001
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Country | US
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Telephone | 623-879-6100
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Fax |
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Provider Business Mailing Address
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Address Line | 12124 W COTTONTAIL LN
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City | PEORIA
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State | AZ
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Zip | 85383-5829
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Country | US
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Telephone | 602-299-4548
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 306567
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN174293
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License Number State | AZ
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