Provider Demographics
NPI:1982150892
Name:MADOURIE, SHAUNA DEAN A (NP-C)
Entity type:Individual
Prefix:
First Name:SHAUNA DEAN
Middle Name:A
Last Name:MADOURIE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:SHAUNA DEAN
Other - Middle Name:ANTOINETTE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6861B W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1600
Mailing Address - Country:US
Mailing Address - Phone:702-329-2722
Mailing Address - Fax:702-329-2724
Practice Address - Street 1:6861B W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1600
Practice Address - Country:US
Practice Address - Phone:702-329-2722
Practice Address - Fax:792-329-2724
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV818032363LF0000X
FL9311091363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily