Provider Demographics
NPI:1992444715
Name:PATTERSON, SHAWNIQUE GIAVONNA
Entity type:Individual
Prefix:
First Name:SHAWNIQUE
Middle Name:GIAVONNA
Last Name:PATTERSON
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 1:620 W CRAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:PINEBLUFF
Mailing Address - State:NC
Mailing Address - Zip Code:28373-8224
Mailing Address - Country:US
Mailing Address - Phone:910-722-6659
Mailing Address - Fax:
Practice Address - Street 1:620 W CRAVEN AVE
Practice Address - Street 2:
Practice Address - City:PINEBLUFF
Practice Address - State:NC
Practice Address - Zip Code:28373-8224
Practice Address - Country:US
Practice Address - Phone:910-722-6659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC514795376K00000X, 376K00000X
372600000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide