Individual
SHANA FEARNLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9990 DOUBLE R BLVD STE 200, RENO, NV 89521-4833
(775) 348-8800
(775) 348-8818
Mailing address
5310 KIETZKE LN STE 104, RENO, NV 89511-2043
(775) 348-8800
(775) 786-1887
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA730
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11426227
CAQH
—
05
—
1861480642
—
NV
Enumeration date
10/06/2005
Last updated
08/25/2022
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