Provider Demographics
NPI:1316101371
Name:PFRUNDER, SHANNON REBECCA (CRNA)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:REBECCA
Last Name:PFRUNDER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6421 WESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-5347
Mailing Address - Country:US
Mailing Address - Phone:951-780-6670
Mailing Address - Fax:
Practice Address - Street 1:6421 WESTVIEW DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-5347
Practice Address - Country:US
Practice Address - Phone:951-780-6670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3699367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty