Provider Demographics
NPI:1457986432
Name:FERRELL, SHAKEENA
Entity type:Individual
Prefix:
First Name:SHAKEENA
Middle Name:
Last Name:FERRELL
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 1:1032 YATES AVE
Mailing Address - Street 2:
Mailing Address - City:MARCUS HOOK
Mailing Address - State:PA
Mailing Address - Zip Code:19061-4635
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1032 YATES AVE
Practice Address - Street 2:
Practice Address - City:MARCUS HOOK
Practice Address - State:PA
Practice Address - Zip Code:19061-4635
Practice Address - Country:US
Practice Address - Phone:267-439-5017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN307286164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse