Provider Demographics
NPI:1437812229
Name:NOEL, SHENEQUA ANASTASIA (LPN)
Entity Type:Individual
Prefix:
First Name:SHENEQUA
Middle Name:ANASTASIA
Last Name:NOEL
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 1:7237 BRITTANY WAY
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-4075
Mailing Address - Country:US
Mailing Address - Phone:470-514-8584
Mailing Address - Fax:
Practice Address - Street 1:7237 BRITTANY WAY
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-4075
Practice Address - Country:US
Practice Address - Phone:470-514-8584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN093135164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse