MEDICARE: SHANICE LASHAE' AVERY REGISTERED NURSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH0200X	Home Health Registered Nurse	449384	OH

General Provider Information

NPI Number	:	1427644806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANICE LASHAE' AVERY REGISTERED NURSE

Provider Business Mailing Address
First Line	:	5715 HINCKLEY CT
Second Line	:
City	:	HUBER HEIGHTS
State	:	OH
Zip	:	45424-3528
Country	:	US
Telephone Number	:	937-469-9987
Fax Number	:

Provider Business Practice Location Address
First Line	:	5715 HINCKLEY CT
Second Line	:
City	:	HUBER HEIGHTS
State	:	OH
Zip	:	45424-3528
Country	:	US
Telephone Number	:	937-469-9987
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2020
Last Update Date	:	12/18/2020

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