Provider Demographics
NPI:1699517631
Name:PICHAY, SHANNEN REAMBONANZA (MSN, FNP-C)
Entity type:Individual
Prefix:MISS
First Name:SHANNEN
Middle Name:REAMBONANZA
Last Name:PICHAY
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:MISS
Other - First Name:SHANNEN VENICE
Other - Middle Name:REAMBONANZA
Other - Last Name:PICHAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN, FNP-C
Mailing Address - Street 1:20305 KLYNE ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-4519
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1477 S MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-2905
Practice Address - Country:US
Practice Address - Phone:782-714-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027312363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily