Provider Demographics
NPI:1477023240
Name:SHYNE-DIXON, LATISHA GENISE (LVN)
Entity Type:Individual
Prefix:
First Name:LATISHA
Middle Name:GENISE
Last Name:SHYNE-DIXON
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 1:5519 RIVULET RUN CT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313-4871
Mailing Address - Country:US
Mailing Address - Phone:661-496-8705
Mailing Address - Fax:661-735-7424
Practice Address - Street 1:5519 RIVULET RUN CT
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93313-4871
Practice Address - Country:US
Practice Address - Phone:661-496-8705
Practice Address - Fax:661-735-7424
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA698878164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse