Provider Demographics
NPI:1083436646
Name:PENSON, SHAUNA LYNN
Entity type:Individual
Prefix:MISS
First Name:SHAUNA
Middle Name:LYNN
Last Name:PENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4407 S AGAVE AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-6395
Mailing Address - Country:US
Mailing Address - Phone:928-390-0613
Mailing Address - Fax:
Practice Address - Street 1:2363 S KENNEDY LN BLDG 3
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-2416
Practice Address - Country:US
Practice Address - Phone:928-390-0613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist