MEDICARE: SHIJUANA OBI CRNA, FNP

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	367500000X	Certified Registered Nurse Anesthetist	819264	NV

General Provider Information

NPI Number	:	1225372733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIJUANA OBI CRNA, FNP

Provider Business Mailing Address
First Line	:	1445 VIA SAVONA DR
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-3127
Country	:	US
Telephone Number	:	803-530-6596
Fax Number	:

Provider Business Practice Location Address
First Line	:	5365 S DURANGO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-2500
Country	:	US
Telephone Number	:	702-254-1777
Fax Number	:

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

Provider Enumeration Date	:	11/21/2012
Last Update Date	:	03/19/2025

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