Provider Demographics
NPI:1003033143
Name:PATERNA, NANCY SHANNON (LPN)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:SHANNON
Last Name:PATERNA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:SHANNON
Other - Last Name:POLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2200 LLOYD DR
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29154-8819
Mailing Address - Country:US
Mailing Address - Phone:803-481-5054
Mailing Address - Fax:
Practice Address - Street 1:2200 LLOYD DR
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29154-8819
Practice Address - Country:US
Practice Address - Phone:803-481-5054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5156746164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse