Provider Demographics
NPI:1992486377
Name:WILSON, SHAUNA R
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:R
Last Name:WILSON
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 1:3498 EASTRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WOODLAWN
Mailing Address - State:TN
Mailing Address - Zip Code:37191-8115
Mailing Address - Country:US
Mailing Address - Phone:931-237-8440
Mailing Address - Fax:
Practice Address - Street 1:250 ARROWOOD DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-5186
Practice Address - Country:US
Practice Address - Phone:931-245-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN123930376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide