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General NPI Number Information
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NPI Number | 1306439328
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Entity Type | Individual
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Provider Name | SHAQUIRAH LASHEA SCREEN
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Gender | Female
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Dates
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Enumeration Date | 02/20/2021
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Last Update Date | 04/15/2021
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Provider Practice Location Address
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Address Line | 925 S WEST ST # ATB
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City | BAINBRIDGE
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State | GA
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Zip | 39819-4519
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Country | US
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Telephone | 229-205-5032
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Fax |
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Provider Business Mailing Address
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Address Line | 925 S WEST ST APT B
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City | BAINBRIDGE
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State | GA
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Zip | 39819-4530
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Country | US
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Telephone | 229-205-5032
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374T00000X
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Taxonomy Name | Religious Nonmedical Nursing Personnel
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License Number |
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License Number State |
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