Provider Demographics
NPI:1861579492
Name:WARREN, SHAWNA A (APRN, BC, ANP)
Entity type:Individual
Prefix:MS
First Name:SHAWNA
Middle Name:A
Last Name:WARREN
Suffix:
Gender:F
Credentials:APRN, BC, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 BARTON HILLS DR
Mailing Address - Street 2:#119
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-2080
Mailing Address - Country:US
Mailing Address - Phone:512-326-3348
Mailing Address - Fax:
Practice Address - Street 1:601 E 15TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1930
Practice Address - Country:US
Practice Address - Phone:512-324-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX693287363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184837603Medicaid
TX823N05OtherBCBS
TX184837604Medicaid
TX8J2723Medicare PIN
TX823N05OtherBCBS