Provider Demographics
NPI:1073706867
Name:WHITAKER, SHANNON LANEE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:LANEE
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 CROASDAILE DRIVE
Mailing Address - Street 2:SUITE 701
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-8324
Mailing Address - Country:US
Mailing Address - Phone:919-309-4333
Mailing Address - Fax:
Practice Address - Street 1:3200 CROASDAILE DRIVE
Practice Address - Street 2:SUITE 701
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-8324
Practice Address - Country:US
Practice Address - Phone:919-309-4333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC06619164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse