Provider Demographics
NPI:1588496681
Name:COENRAAD, SHAWNEY
Entity type:Individual
Prefix:
First Name:SHAWNEY
Middle Name:
Last Name:COENRAAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:846 PARK AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-2135
Mailing Address - Country:US
Mailing Address - Phone:605-277-6870
Mailing Address - Fax:
Practice Address - Street 1:846 PARK AVE APT 202
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2135
Practice Address - Country:US
Practice Address - Phone:605-277-6870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer