Provider Demographics
NPI:1215098512
Name:ABDEL-SHAKUR, LA NEICE LORRAINE (CNM)
Entity type:Individual
Prefix:MRS
First Name:LA NEICE
Middle Name:LORRAINE
Last Name:ABDEL-SHAKUR
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MISS
Other - First Name:LA NEICE
Other - Middle Name:LORRAINE
Other - Last Name:PERKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:101 BODIN CIR
Mailing Address - Street 2:WOMEN'S HEALTH
Mailing Address - City:TRAVIS AFB
Mailing Address - State:CA
Mailing Address - Zip Code:94535-1809
Mailing Address - Country:US
Mailing Address - Phone:707-423-5406
Mailing Address - Fax:707-423-7356
Practice Address - Street 1:101 BODIN CIR
Practice Address - Street 2:DAVID GRANT MEDICAL CENTER
Practice Address - City:TRAVIS AFB
Practice Address - State:CA
Practice Address - Zip Code:94535-1809
Practice Address - Country:US
Practice Address - Phone:707-423-5406
Practice Address - Fax:707-423-7356
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA704600163WX0003X
CA1906367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient