Provider Demographics
NPI:1972760064
Name:SHOCKLEY, CHRISTINA LEE (LPN)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:LEE
Last Name:SHOCKLEY
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 1:20 WILLIS RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-4079
Mailing Address - Country:US
Mailing Address - Phone:302-747-7698
Mailing Address - Fax:
Practice Address - Street 1:314 E MAIN ST
Practice Address - Street 2:SUITE 101 KELWAY PLAZA
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-7128
Practice Address - Country:US
Practice Address - Phone:302-738-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-17
Last Update Date:2008-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL20009400164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse