Provider Demographics
NPI:1437653631
Name:LINK, SHANTRELL (LVN)
Entity Type:Individual
Prefix:
First Name:SHANTRELL
Middle Name:
Last Name:LINK
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 1:504 ROSWELL LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-4798
Mailing Address - Country:US
Mailing Address - Phone:682-564-4950
Mailing Address - Fax:
Practice Address - Street 1:504 ROSWELL LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-4798
Practice Address - Country:US
Practice Address - Phone:682-564-4950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX222991164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse