Provider Demographics
NPI:1285381152
Name:RICHEY, SHAUNA JOY (FNP-BC)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:JOY
Last Name:RICHEY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 GRAYSTONE
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-7901
Mailing Address - Country:US
Mailing Address - Phone:231-620-4171
Mailing Address - Fax:
Practice Address - Street 1:555 GRAYSTONE
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-7901
Practice Address - Country:US
Practice Address - Phone:231-620-4171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIF12210656363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner