MEDICARE: SHAWNA PATRICE MARION CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	0000151934	TN
2	363LF0000X	Family Nurse Practitioner	12390	TN
3	363LF0000X	Family Nurse Practitioner	APN56978	NM
4	363L00000X	Nurse Practitioner	56878	NM

General Provider Information

NPI Number	:	1043379456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWNA PATRICE MARION CNP

Provider Business Mailing Address
First Line	:	PO BOX 26666
Second Line	:	PROVIDER ENROLLMENT
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87125-6666
Country	:	US
Telephone Number	:	505-923-6770
Fax Number	:	505-923-5354

Provider Business Practice Location Address
First Line	:	4100 HIGH RESORT BLVD SE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87124-5901
Country	:	US
Telephone Number	:	505-291-2222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	07/25/2023

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Directions to “ SHAWNA PATRICE MARION CNP” Practice Location

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