MEDICARE: SHAKERA CANTY LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	49592	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	62-2180901	OTHER	SC	GOVERMENT

General Provider Information

NPI Number	:	1003663154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAKERA CANTY LPN

Provider Business Mailing Address
First Line	:	218 SPRING ST APT 115
Second Line	:
City	:	LAURENS
State	:	SC
Zip	:	29360-1868
Country	:	US
Telephone Number	:	864-399-4415
Fax Number	:

Provider Business Practice Location Address
First Line	:	218 SPRING ST APT 115
Second Line	:
City	:	LAURENS
State	:	SC
Zip	:	29360-1868
Country	:	US
Telephone Number	:	864-399-4415
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2024
Last Update Date	:	05/06/2024

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Directions to “ SHAKERA CANTY LPN” Practice Location

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