Provider Demographics
NPI:1962729020
Name:PANTHER-WILBURG, SHAKIRA MARIE (RN)
Entity type:Individual
Prefix:MRS
First Name:SHAKIRA
Middle Name:MARIE
Last Name:PANTHER-WILBURG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:SHAKIRA
Other - Middle Name:MARIE
Other - Last Name:PANTHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14136 256TH ST
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-3325
Mailing Address - Country:US
Mailing Address - Phone:347-728-7371
Mailing Address - Fax:
Practice Address - Street 1:14136 256TH ST
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-3325
Practice Address - Country:US
Practice Address - Phone:347-728-7371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY619092163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse