Provider Demographics
NPI:1407280761
Name:CARGILL, SHATANIE MARIE
Entity Type:Individual
Prefix:MISS
First Name:SHATANIE
Middle Name:MARIE
Last Name:CARGILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 ZAHN DR APT A
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-5517
Mailing Address - Country:US
Mailing Address - Phone:330-983-6842
Mailing Address - Fax:
Practice Address - Street 1:511 ZAHN DR APT A
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-5517
Practice Address - Country:US
Practice Address - Phone:330-983-6842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide