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General NPI Number Information
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NPI Number | 1679426035
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Entity Type | Individual
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Provider Name | SHANU KHATANA
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Gender | Female
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Dates
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Enumeration Date | 02/17/2026
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Last Update Date | 02/17/2026
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Provider Practice Location Address
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Address Line | 14200 W CELEBRATE LIFE WAY
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City | GOODYEAR
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State | AZ
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Zip | 85338-3007
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Country | US
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Telephone | 847-342-6910
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Fax |
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Provider Business Mailing Address
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Address Line | 9515 TAMAR TRL
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City | FORT WAYNE
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State | IN
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Zip | 46825-7254
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Country | US
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Telephone |
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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 | TEMP335624
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License Number State | AZ
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