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General NPI Number Information
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NPI Number | 1801568191
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Entity Type | Individual
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Provider Name | LAPRECE SHAW STNA/LPN
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Gender | Female
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Dates
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Enumeration Date | 10/04/2021
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Last Update Date | 10/04/2021
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Provider Practice Location Address
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Address Line | 5981 MARVIN ST
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City | TAYLOR
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State | MI
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Zip | 48180-1188
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Country | US
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Telephone | 419-984-6982
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Fax |
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Provider Business Mailing Address
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Address Line | 3 RAVINE PARK VLG
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City | TOLEDO
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State | OH
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Zip | 43605-4905
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Country | US
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Telephone | 419-984-6982
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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 | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 32222191440512
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 230014192390608
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License Number State | MI
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