Provider Demographics
NPI:1477185791
Name:PHANEUF, SHANDIS DENISE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SHANDIS
Middle Name:DENISE
Last Name:PHANEUF
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:SHANDIS
Other - Middle Name:DENISE
Other - Last Name:PHANEUF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SHANDIS PHANEUF LPN
Mailing Address - Street 1:6545 GREGG DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-3273
Mailing Address - Country:US
Mailing Address - Phone:334-663-4278
Mailing Address - Fax:
Practice Address - Street 1:6545 GREGG DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909
Practice Address - Country:US
Practice Address - Phone:334-663-4278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALON066099164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse