Provider Demographics
NPI:1962975102
Name:SHOTWELL, CAROL JEANETTE (LVN)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:JEANETTE
Last Name:SHOTWELL
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:LAMESA
Mailing Address - State:TX
Mailing Address - Zip Code:79331-0457
Mailing Address - Country:US
Mailing Address - Phone:806-752-1916
Mailing Address - Fax:
Practice Address - Street 1:318 N HWY 137
Practice Address - Street 2:
Practice Address - City:WELCH
Practice Address - State:TX
Practice Address - Zip Code:79377
Practice Address - Country:US
Practice Address - Phone:806-752-1916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX307803164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse