Provider Demographics
NPI:1215201397
Name:RANSOM, SHANAE KATRICE (LVN)
Entity type:Individual
Prefix:MS
First Name:SHANAE
Middle Name:KATRICE
Last Name:RANSOM
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:PO BOX 5273
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92517-5273
Mailing Address - Country:US
Mailing Address - Phone:626-337-0424
Mailing Address - Fax:
Practice Address - Street 1:14514 RAMONA BLVD
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-3305
Practice Address - Country:US
Practice Address - Phone:626-337-0424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2027473747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant