Provider Demographics
NPI:1194284596
Name:LAVINIER-BROWN, SHANELLE (LPN)
Entity type:Individual
Prefix:
First Name:SHANELLE
Middle Name:
Last Name:LAVINIER-BROWN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23271 KIPLING ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-3636
Mailing Address - Country:US
Mailing Address - Phone:248-802-9980
Mailing Address - Fax:
Practice Address - Street 1:23271 KIPLING ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-3636
Practice Address - Country:US
Practice Address - Phone:248-802-9980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703120073164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse