1134401482 NPI number — SHAWNA DEANNE STEFFAN PA-C

Table of content: SHAWNA DEANNE STEFFAN PA-C (NPI 1134401482)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134401482 NPI number — SHAWNA DEANNE STEFFAN PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEFFAN
Provider First Name:
SHAWNA
Provider Middle Name:
DEANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MEAD
Provider Other First Name:
SHAWNA
Provider Other Middle Name:
DEANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134401482
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 W CRESCENT PARK
Provider Second Line Business Mailing Address:
CREDENTIALS OFFICE
Provider Business Mailing Address City Name:
WARREN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16365-2111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-723-4973
Provider Business Mailing Address Fax Number:
814-726-9416

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 W CRESCENT PARK FL 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16365-2111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-726-0273
Provider Business Practice Location Address Fax Number:
814-726-9416
Provider Enumeration Date:
09/13/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  OA003320 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: MA052582 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)