Provider Demographics
NPI:1295610632
Name:MANNING, SHENA ANTRONETTE (RN)
Entity type:Individual
Prefix:
First Name:SHENA
Middle Name:ANTRONETTE
Last Name:MANNING
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SHENA
Other - Middle Name:ANTRONETTE
Other - Last Name:SHEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6040 E MAIN ST STE 149
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-8928
Mailing Address - Country:US
Mailing Address - Phone:773-513-9131
Mailing Address - Fax:
Practice Address - Street 1:6340 E BOISE ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-8341
Practice Address - Country:US
Practice Address - Phone:773-513-9131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN209840163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice