Provider Demographics
NPI:1457511636
Name:REMBERT, SHANNON VYSHA (LPN)
Entity Type:Individual
Prefix:MISS
First Name:SHANNON
Middle Name:VYSHA
Last Name:REMBERT
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 1:24 HILLTOP LN
Mailing Address - Street 2:
Mailing Address - City:WHEATLEY HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11798-1304
Mailing Address - Country:US
Mailing Address - Phone:631-478-2949
Mailing Address - Fax:
Practice Address - Street 1:24 HILLTOP LN
Practice Address - Street 2:
Practice Address - City:WHEATLEY HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11798-1304
Practice Address - Country:US
Practice Address - Phone:631-478-2949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2745641164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse