Provider Demographics
NPI:1275021115
Name:SHEARIN, WILBUR THADDEUS III (LPN)
Entity Type:Individual
Prefix:
First Name:WILBUR
Middle Name:THADDEUS
Last Name:SHEARIN
Suffix:III
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7235 BROCKINGTON DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-7065
Mailing Address - Country:US
Mailing Address - Phone:843-999-5105
Mailing Address - Fax:
Practice Address - Street 1:7235 BROCKINGTON DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-7065
Practice Address - Country:US
Practice Address - Phone:843-999-5105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC71080164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse