Provider Demographics
NPI:1184227290
Name:SHECKLES, NIA DENESE (LPN)
Entity Type:Individual
Prefix:
First Name:NIA
Middle Name:DENESE
Last Name:SHECKLES
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 1:6000 DESMOND ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-1812
Mailing Address - Country:US
Mailing Address - Phone:513-442-6022
Mailing Address - Fax:
Practice Address - Street 1:6000 DESMOND ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-1812
Practice Address - Country:US
Practice Address - Phone:513-442-6022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN101155164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse