MEDICARE: SHENEKA YVONNE LANE CNA

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	376K00000X	Nurse's Aide	1401150248	VA

General Provider Information

NPI Number	:	1083057889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHENEKA YVONNE LANE CNA

Provider Business Mailing Address
First Line	:	2208 AFTON AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23224-8104
Country	:	US
Telephone Number	:	804-496-9828
Fax Number	:

Provider Business Practice Location Address
First Line	:	2208 AFTON AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23224-8104
Country	:	US
Telephone Number	:	804-496-9828
Fax Number	:

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

Provider Enumeration Date	:	04/10/2013
Last Update Date	:	04/10/2013

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