Provider Demographics
NPI:1114699287
Name:MAY, SHANA (PMHNP)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:MAY
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:
Other - Last Name:HOWERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1387
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-1387
Mailing Address - Country:US
Mailing Address - Phone:208-415-0299
Mailing Address - Fax:208-625-2070
Practice Address - Street 1:1038 NORTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2249
Practice Address - Country:US
Practice Address - Phone:208-620-5210
Practice Address - Fax:844-807-3782
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID44855163W00000X
ID70200363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health