Provider Demographics
NPI:1073757233
Name:GARCIA, SHELLY L (LPN)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:L
Last Name:GARCIA
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 1:357 E CORPORATE DR
Mailing Address - Street 2:APT 213
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-2319
Mailing Address - Country:US
Mailing Address - Phone:505-417-7868
Mailing Address - Fax:
Practice Address - Street 1:357 E CORPORATE DR
Practice Address - Street 2:APT 213
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-2319
Practice Address - Country:US
Practice Address - Phone:505-417-7868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206530164W00000X
NML14017164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse