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1063976462 NPI number — SHAKENDRA LEE RN

NPI Number: 1063976462
Health Care Provider/Practitioner: SHAKENDRA LEE RN

Information about “1063976462” NPI (SHAKENDRA LEE RN) exists in 1063976462 in HTML format HTML  |  1063976462 in plain Text format TXT  |  1063976462 in PDF (Portable Document Format) PDF  |  1063976462 in an XML format XML  formats.

NPI Number : 1063976462 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1063976462",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LEE",
    "FirstName": "SHAKENDRA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "RN",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "POLK",
    "OtherFirstName": "SHAKENDRA",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "RN",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "3035 S MARYLAND PKWY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAS VEGAS",
    "MailingAddressStateName": "NV",
    "MailingAddressPostalCode": "89109-2200",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3035 S MARYLAND PKWY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LAS VEGAS",
    "PracticeLocationAddressStateName": "NV",
    "PracticeLocationAddressPostalCode": "89109-2200",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "702-376-4557",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/30/2019",
    "LastUpdateDate": "08/20/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "163W00000X",
          "TaxonomyName": "Registered Nurse",
          "LicenseNumber": "846512",
          "LicenseNumberStateCode": "NV",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "163WP0808X",
          "TaxonomyName": "Psychiatric/Mental Health Registered Nurse",
          "LicenseNumber": "846512",
          "LicenseNumberStateCode": "NV",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "167G00000X",
          "TaxonomyName": "Licensed Psychiatric Technician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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