Provider Demographics
NPI:1184826463
Name:SHAW, LORI KAYE (LVN)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:KAYE
Last Name:SHAW
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MRS
Other - First Name:LORI
Other - Middle Name:KAYE
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:PO BOX 64
Mailing Address - Street 2:
Mailing Address - City:MABANK
Mailing Address - State:TX
Mailing Address - Zip Code:75147-0064
Mailing Address - Country:US
Mailing Address - Phone:903-887-9773
Mailing Address - Fax:903-887-1445
Practice Address - Street 1:2802 VANZANDT CO.RD.
Practice Address - Street 2:#2685HOUSE NO.
Practice Address - City:MABANK
Practice Address - State:TX
Practice Address - Zip Code:75147-2685
Practice Address - Country:US
Practice Address - Phone:903-887-9773
Practice Address - Fax:903-887-1445
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX128408164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse