Provider Demographics
NPI:1497491187
Name:MCCARROLL, SHMONICA LANAE
Entity Type:Individual
Prefix:MS
First Name:SHMONICA
Middle Name:LANAE
Last Name:MCCARROLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 WOODCREST ROAD
Mailing Address - Street 2:B
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205
Mailing Address - Country:US
Mailing Address - Phone:205-499-3008
Mailing Address - Fax:
Practice Address - Street 1:1714 WOODCREST ROAD
Practice Address - Street 2:B
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-3520
Practice Address - Country:US
Practice Address - Phone:205-499-3008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-158073163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse