Provider Demographics
NPI:1376317107
Name:SHIREY, KAELA DANAE (LPN)
Entity Type:Individual
Prefix:
First Name:KAELA
Middle Name:DANAE
Last Name:SHIREY
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 1:96 LINWOOD PLZ STE 303
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-3701
Mailing Address - Country:US
Mailing Address - Phone:516-343-2772
Mailing Address - Fax:740-529-0553
Practice Address - Street 1:2266 WAKEFIELD MOUND RD
Practice Address - Street 2:
Practice Address - City:PIKETON
Practice Address - State:OH
Practice Address - Zip Code:45661-9660
Practice Address - Country:US
Practice Address - Phone:516-343-2772
Practice Address - Fax:740-529-0553
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.187175164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse