Provider Demographics
NPI:1073758173
Name:STARKS, SHUNETTA DEVON (LPN)
Entity Type:Individual
Prefix:MS
First Name:SHUNETTA
Middle Name:DEVON
Last Name:STARKS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:STAR
Other - Middle Name:DEVON
Other - Last Name:STARKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:5482 LEASURE ST
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-3752
Mailing Address - Country:US
Mailing Address - Phone:330-983-6815
Mailing Address - Fax:
Practice Address - Street 1:5482 LEASURE ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3752
Practice Address - Country:US
Practice Address - Phone:330-983-6815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH130803-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse