Provider Demographics
NPI:1437803038
Name:GILBERT, SHINEATRA (LPN)
Entity Type:Individual
Prefix:
First Name:SHINEATRA
Middle Name:
Last Name:GILBERT
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 1:395 VILLA ROSA RD APT G2
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:GA
Mailing Address - Zip Code:30179-7303
Mailing Address - Country:US
Mailing Address - Phone:979-777-3460
Mailing Address - Fax:
Practice Address - Street 1:395 VILLA ROSA RD APT G2
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:GA
Practice Address - Zip Code:30179-7303
Practice Address - Country:US
Practice Address - Phone:979-777-3460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA098322164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse