Provider Demographics
NPI:1558074062
Name:ROSS, SHONETELL RENEE (LPN)
Entity Type:Individual
Prefix:MS
First Name:SHONETELL
Middle Name:RENEE
Last Name:ROSS
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 1:121 BARNETT CT
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70507-2764
Mailing Address - Country:US
Mailing Address - Phone:337-200-0372
Mailing Address - Fax:
Practice Address - Street 1:121 BARNETT CT
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70507-2764
Practice Address - Country:US
Practice Address - Phone:337-200-0372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA20180242164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse