Provider Demographics
NPI:1144425752
Name:STANSBERRY, SHONDA KAY (RN)
Entity Type:Individual
Prefix:
First Name:SHONDA
Middle Name:KAY
Last Name:STANSBERRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 S RICHARDSON AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-3242
Mailing Address - Country:US
Mailing Address - Phone:614-274-6431
Mailing Address - Fax:
Practice Address - Street 1:191 S RICHARDSON AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-3242
Practice Address - Country:US
Practice Address - Phone:614-274-6431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN275704163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2362527Medicaid
OHRN275704OtherNURSING LICENSE NUMBER