Provider Demographics
NPI:1396147062
Name:HOWARD, SHAWNTAE (LPN)
Entity type:Individual
Prefix:
First Name:SHAWNTAE
Middle Name:
Last Name:HOWARD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4876 E 90TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44125-2128
Mailing Address - Country:US
Mailing Address - Phone:216-703-2773
Mailing Address - Fax:
Practice Address - Street 1:4876 E 90TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44125-2128
Practice Address - Country:US
Practice Address - Phone:216-703-2773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN135355164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse