Provider Demographics
NPI:1902958614
Name:CHRISTIANSEN THISTLE, SHAUNA D (MD)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:D
Last Name:CHRISTIANSEN THISTLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHAUNA
Other - Middle Name:
Other - Last Name:CHRISTIANSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1800 W CHARLESTON BLVD
Mailing Address - Street 2:501
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102
Mailing Address - Country:US
Mailing Address - Phone:702-383-2688
Mailing Address - Fax:702-671-6595
Practice Address - Street 1:9320 W SAHARA
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117
Practice Address - Country:US
Practice Address - Phone:702-383-3633
Practice Address - Fax:702-562-2810
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9004207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H13320Medicare UPIN