Healthcare Provider Details

I. General information

NPI: 1306415740
Provider Name (Legal Business Name): SHANETHIA DANYELLE WINSTON LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 KAREN AVE
LAS VEGAS NV
89109-1264
US

IV. Provider business mailing address

900 KAREN AVE
LAS VEGAS NV
89109-1264
US

V. Phone/Fax

Practice location:
  • Phone: 702-416-0553
  • Fax:
Mailing address:
  • Phone: 702-416-0553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: