Provider Demographics
NPI:1306510847
Name:STALLWORTH, VANESHIA VENEA (RN)
Entity type:Individual
Prefix:
First Name:VANESHIA
Middle Name:VENEA
Last Name:STALLWORTH
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 1:1361 10TH AVE STE D
Mailing Address - Street 2:
Mailing Address - City:CALERA
Mailing Address - State:AL
Mailing Address - Zip Code:35040-6253
Mailing Address - Country:US
Mailing Address - Phone:205-218-6878
Mailing Address - Fax:
Practice Address - Street 1:1361 10TH AVE STE D
Practice Address - Street 2:
Practice Address - City:CALERA
Practice Address - State:AL
Practice Address - Zip Code:35040-6253
Practice Address - Country:US
Practice Address - Phone:205-218-6878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-08
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-160804163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health