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General NPI Number Information
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NPI Number | 1609416676
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Entity Type | Individual
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Provider Name | SHANTEL LATORIA CARSWELL LPN
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Gender | Female
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Dates
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Enumeration Date | 01/08/2020
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Last Update Date | 01/08/2020
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Provider Practice Location Address
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Address Line | 1974 WALTON NICHOLSON PIKE
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City | INDEPENDENCE
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State | KY
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Zip | 41051-7906
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Country | US
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Telephone | 859-359-5404
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Fax |
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Provider Business Mailing Address
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Address Line | 523 ROEBLING RD
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City | CINCINNATI
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State | OH
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Zip | 45238-5529
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Country | US
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Telephone | 513-869-3911
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 2054476
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License Number State | KY
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