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General NPI Number Information
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NPI Number | 1316703846
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Entity Type | Individual
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Provider Name | LATEESHIA COURTNEY SHOOTS LVN
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Gender | Female
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Dates
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Enumeration Date | 02/22/2024
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Last Update Date | 02/22/2024
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Provider Practice Location Address
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Address Line | 7240 E SOUTHGATE DR STE G
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City | SACRAMENTO
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State | CA
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Zip | 95823-2627
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Country | US
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Telephone | 916-391-4293
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Fax |
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Provider Business Mailing Address
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Address Line | 6503 WESLEY AVE
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City | SACRAMENTO
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State | CA
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Zip | 95823-1114
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Country | US
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Telephone | 661-544-0841
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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 | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 739354
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License Number State | CA
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