Provider Demographics
NPI:1316152317
Name:SHACKLE, LADONNA MARIE (STNA)
Entity type:Individual
Prefix:
First Name:LADONNA
Middle Name:MARIE
Last Name:SHACKLE
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 HIGH ST NW
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:OH
Mailing Address - Zip Code:44662-1131
Mailing Address - Country:US
Mailing Address - Phone:330-791-7014
Mailing Address - Fax:
Practice Address - Street 1:235 HIGH ST NW
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:OH
Practice Address - Zip Code:44662-1131
Practice Address - Country:US
Practice Address - Phone:330-791-7014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2008-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide