Provider Demographics
NPI:1497942940
Name:SLAYTON, SHAMIRRA MARQUISE (LPN)
Entity Type:Individual
Prefix:MS
First Name:SHAMIRRA
Middle Name:MARQUISE
Last Name:SLAYTON
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 1:8453 VINTAGE LN
Mailing Address - Street 2:
Mailing Address - City:MACEDONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44056-2703
Mailing Address - Country:US
Mailing Address - Phone:330-467-6979
Mailing Address - Fax:
Practice Address - Street 1:8453 VINTAGE LN
Practice Address - Street 2:
Practice Address - City:MACEDONIA
Practice Address - State:OH
Practice Address - Zip Code:44056-2703
Practice Address - Country:US
Practice Address - Phone:330-467-6979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN101455164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse