Provider Demographics
NPI:1417623034
Name:BROWN, SHANDA N (LVN)
Entity Type:Individual
Prefix:
First Name:SHANDA
Middle Name:N
Last Name:BROWN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 N ELKHART AVE APT A
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-1446
Mailing Address - Country:US
Mailing Address - Phone:737-808-5898
Mailing Address - Fax:
Practice Address - Street 1:613 N ELKHART AVE APT A
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-1446
Practice Address - Country:US
Practice Address - Phone:737-808-5898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX322695164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse