Provider Demographics
NPI:1003433111
Name:FLANAGAN, SHANITA (CNA - CERTIFIED NURS)
Entity Type:Individual
Prefix:MRS
First Name:SHANITA
Middle Name:
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:CNA - CERTIFIED NURS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4519 SOUTHWESTERN PARKWAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40212
Mailing Address - Country:US
Mailing Address - Phone:502-471-1292
Mailing Address - Fax:
Practice Address - Street 1:4519 SOUTHWESTERN PARKWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40212
Practice Address - Country:US
Practice Address - Phone:502-471-1292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide