Provider Demographics
NPI:1427623727
Name:BRICKLES, SHAWNA D
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:D
Last Name:BRICKLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3593 MCLELLAN HWY
Mailing Address - Street 2:
Mailing Address - City:BRANCHLAND
Mailing Address - State:WV
Mailing Address - Zip Code:25506
Mailing Address - Country:US
Mailing Address - Phone:681-279-9345
Mailing Address - Fax:
Practice Address - Street 1:3593 MCLELLAN HWY
Practice Address - Street 2:
Practice Address - City:BRANCHLAND
Practice Address - State:WV
Practice Address - Zip Code:25506
Practice Address - Country:US
Practice Address - Phone:681-279-9345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant