Provider Demographics
NPI:1245588631
Name:UPSHAW, SONYA RENEE (LVN)
Entity Type:Individual
Prefix:MS
First Name:SONYA
Middle Name:RENEE
Last Name:UPSHAW
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:SONYA
Other - Middle Name:RENEE
Other - Last Name:GRAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:7333 POTRANCO RD
Mailing Address - Street 2:STE 50102
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-2187
Mailing Address - Country:US
Mailing Address - Phone:210-400-7077
Mailing Address - Fax:
Practice Address - Street 1:7333 POTRANCO RD
Practice Address - Street 2:STE 50102
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-2187
Practice Address - Country:US
Practice Address - Phone:210-400-7077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX220420164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse