Provider Demographics
NPI:1073745063
Name:SHANDS, CATHERINE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:
Last Name:SHANDS
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 1:6323 W CLARKE ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-1411
Mailing Address - Country:US
Mailing Address - Phone:414-578-6542
Mailing Address - Fax:
Practice Address - Street 1:6323 W CLARKE ST
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-1411
Practice Address - Country:US
Practice Address - Phone:414-578-6542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31310-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse