Provider Demographics
NPI:1497346027
Name:ROSE, SHAINA CELESTE (CNA, CCMA)
Entity Type:Individual
Prefix:MRS
First Name:SHAINA
Middle Name:CELESTE
Last Name:ROSE
Suffix:
Gender:F
Credentials:CNA, CCMA
Other - Prefix:MRS
Other - First Name:SHAINA
Other - Middle Name:CELESTE
Other - Last Name:VIPPERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA, CCMA
Mailing Address - Street 1:8197 SENECA TRL S
Mailing Address - Street 2:
Mailing Address - City:LINDSIDE
Mailing Address - State:WV
Mailing Address - Zip Code:24951-7004
Mailing Address - Country:US
Mailing Address - Phone:304-888-5162
Mailing Address - Fax:
Practice Address - Street 1:8197 SENECA TRL S
Practice Address - Street 2:
Practice Address - City:LINDSIDE
Practice Address - State:WV
Practice Address - Zip Code:24951-7004
Practice Address - Country:US
Practice Address - Phone:304-888-5162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant