Provider Demographics
NPI:1114710944
Name:CROWDER, SHONNA CHARIE
Entity type:Individual
Prefix:
First Name:SHONNA
Middle Name:CHARIE
Last Name:CROWDER
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 1:20749 MAMMOTH DR
Mailing Address - Street 2:
Mailing Address - City:LAKEHEAD
Mailing Address - State:CA
Mailing Address - Zip Code:96051-9605
Mailing Address - Country:US
Mailing Address - Phone:209-420-9634
Mailing Address - Fax:
Practice Address - Street 1:20749 MAMMOTH DR
Practice Address - Street 2:
Practice Address - City:LAKEHEAD
Practice Address - State:CA
Practice Address - Zip Code:96051-9605
Practice Address - Country:US
Practice Address - Phone:209-420-9634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-24
Last Update Date:2025-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula