Provider Demographics
NPI:1508999467
Name:FLOYD, SHAWN DESIREE I (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SHAWN
Middle Name:DESIREE
Last Name:FLOYD
Suffix:I
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 1:212 ADAMS CT
Mailing Address - Street 2:
Mailing Address - City:POTTERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48876-9501
Mailing Address - Country:US
Mailing Address - Phone:517-599-0425
Mailing Address - Fax:419-492-9506
Practice Address - Street 1:212 ADAMS CT
Practice Address - Street 2:
Practice Address - City:POTTERVILLE
Practice Address - State:MI
Practice Address - Zip Code:48876-9501
Practice Address - Country:US
Practice Address - Phone:517-599-0425
Practice Address - Fax:419-492-9506
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN113942164W00000X
MI4703109919164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse