Provider Demographics
NPI:1063914901
Name:SHELTON, SHANNON MARIE (LVN)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARIE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 WALL ST
Mailing Address - Street 2:
Mailing Address - City:WINDOM
Mailing Address - State:TX
Mailing Address - Zip Code:75492-5406
Mailing Address - Country:US
Mailing Address - Phone:903-449-8723
Mailing Address - Fax:
Practice Address - Street 1:308 WALL ST
Practice Address - Street 2:
Practice Address - City:WINDOM
Practice Address - State:TX
Practice Address - Zip Code:75492-5406
Practice Address - Country:US
Practice Address - Phone:903-449-8723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX217286164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse