Provider Demographics
NPI:1285822569
Name:SHAUGHNESSY, CATHERINE MARIE (LPN)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:MARIE
Last Name:SHAUGHNESSY
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 1:1335 NW HUNTSVILLE CHURCH DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-8566
Mailing Address - Country:US
Mailing Address - Phone:386-758-9738
Mailing Address - Fax:
Practice Address - Street 1:1335 NW HUNTSVILLE CHURCH DR
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-8566
Practice Address - Country:US
Practice Address - Phone:386-758-9738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5162130164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse