Provider Demographics
NPI:1386928703
Name:VANGRONIGEN, SHAWN (PA)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:VANGRONIGEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3827 N 10TH ST STE 305
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-1745
Mailing Address - Country:US
Mailing Address - Phone:956-803-0748
Mailing Address - Fax:
Practice Address - Street 1:325 MALL DR STE 111
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-5916
Practice Address - Country:US
Practice Address - Phone:559-583-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21123363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant