Provider Demographics
NPI:1679771182
Name:SHIBUYA, ANN M (RN MS)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:M
Last Name:SHIBUYA
Suffix:
Gender:F
Credentials:RN MS
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 N EL DORADO PL
Mailing Address - Street 2:SUITE H800
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715
Mailing Address - Country:US
Mailing Address - Phone:520-296-6920
Mailing Address - Fax:520-290-4534
Practice Address - Street 1:1200 N EL DORADO PL
Practice Address - Street 2:SUITE H800
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715
Practice Address - Country:US
Practice Address - Phone:520-296-6920
Practice Address - Fax:520-290-4534
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC0547101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional