Provider Demographics
NPI:1205397429
Name:BANKS, SHAUNTAE D'NAE (LVN)
Entity Type:Individual
Prefix:
First Name:SHAUNTAE
Middle Name:D'NAE
Last Name:BANKS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 E BATES ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79403-4205
Mailing Address - Country:US
Mailing Address - Phone:806-702-3933
Mailing Address - Fax:
Practice Address - Street 1:3501 E BATES ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79403-4205
Practice Address - Country:US
Practice Address - Phone:806-702-3933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX347841164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse