Provider Demographics
NPI:1285966507
Name:VAZQUEZ, SHANA D (RN)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:D
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13677 GLEN VISTA LN
Mailing Address - Street 2:
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928-6082
Mailing Address - Country:US
Mailing Address - Phone:808-778-3901
Mailing Address - Fax:
Practice Address - Street 1:21227 TORCH ST
Practice Address - Street 2:
Practice Address - City:FT BLISS
Practice Address - State:TX
Practice Address - Zip Code:79918
Practice Address - Country:US
Practice Address - Phone:915-742-9232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1114997163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VADOOOtherUPIN