Individual
SHANNON NGUYEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
601 W MAPLE AVE STE 503, SPRINGDALE, AR 72764
(479) 751-3722
(479) 751-1099
Mailing address
601 W MAPLE AVE STE 503, SPRINGDALE, AR 72764-5376
(479) 751-3722
(479) 751-1099
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
2018029466
MO
367500000X
Certified Registered Nurse Anesthetist
Primary
C003264
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
231408001
—
AR
01
—
5DN38
BCBS ARKANSAS
AR
05
—
910060005
—
MO
Enumeration date
08/08/2018
Last updated
06/18/2021
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