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General NPI Number Information
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NPI Number | 1851794671
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Entity Type | Individual
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Provider Name | SHAWNTEKA THREATT
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Gender | Female
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Dates
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Enumeration Date | 10/07/2014
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Last Update Date | 06/05/2017
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Provider Practice Location Address
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Address Line | 914 GALAT WAY
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City | AKRON
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State | OH
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Zip | 44307-1027
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Country | US
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Telephone | 234-817-2733
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Fax |
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Provider Business Mailing Address
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Address Line | 1275 HARTFORD AVE
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City | AKRON
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State | OH
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Zip | 44320
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Country | US
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Telephone | 330-203-4484
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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 | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 401193490111
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 164350
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License Number State | OH
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