Provider Demographics
NPI:1386884930
Name:BRADSHAW, SHAUNA NORTHCRAFT (CRNP)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:NORTHCRAFT
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66345 N MOSS RUN RD
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:OH
Mailing Address - Zip Code:43906-9777
Mailing Address - Country:US
Mailing Address - Phone:740-671-3021
Mailing Address - Fax:740-671-3021
Practice Address - Street 1:102 PLAZA WEST
Practice Address - Street 2:
Practice Address - City:ST. CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950
Practice Address - Country:US
Practice Address - Phone:740-671-3021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH301518-COA1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily