Provider Demographics
NPI:1588496269
Name:WHITE, SHAWNA M (RN)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:M
Last Name:WHITE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SHAWNA
Other - Middle Name:M
Other - Last Name:STOVALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:P.O. BOX 2
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:71943-9998
Mailing Address - Country:US
Mailing Address - Phone:501-366-5275
Mailing Address - Fax:
Practice Address - Street 1:P.O. BOX 2
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:AR
Practice Address - Zip Code:71943-9998
Practice Address - Country:US
Practice Address - Phone:501-366-5275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR099337163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health