MEDICARE: MISS DENISE SHAKINA ALLISON CLARKE 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	178382	OH

General Provider Information

NPI Number	:	1477126092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DENISE SHAKINA ALLISON CLARKE LPN

Provider Business Mailing Address
First Line	:	1386 E 26TH AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43211-2210
Country	:	US
Telephone Number	:	704-302-6812
Fax Number	:

Provider Business Practice Location Address
First Line	:	1386 E 26TH AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43211-2210
Country	:	US
Telephone Number	:	704-302-6812
Fax Number	:

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

Provider Enumeration Date	:	07/21/2021
Last Update Date	:	01/26/2026

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