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General NPI Number Information
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NPI Number | 1912545989
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Entity Type | Individual
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Provider Name | PAMELA SUE SHANKS LPN
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Gender | Female
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Dates
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Enumeration Date | 12/20/2019
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Last Update Date | 12/20/2019
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Provider Practice Location Address
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Address Line | 313 CHILLICOTHE AVE
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City | HILLSBORO
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State | OH
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Zip | 45133-7378
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Country | US
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Telephone | 937-393-4562
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Fax |
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Provider Business Mailing Address
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Address Line | 116 DEWEY DR
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City | SARDINIA
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State | OH
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Zip | 45171-9598
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Country | US
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Telephone | 937-336-7368
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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 | 126702
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License Number State | OH
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