Provider Demographics
NPI:1558714105
Name:REEGAN, STASHANAE (LVN)
Entity Type:Individual
Prefix:
First Name:STASHANAE
Middle Name:
Last Name:REEGAN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 ACKERFIELD AVE APT 210
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-4975
Mailing Address - Country:US
Mailing Address - Phone:562-499-9314
Mailing Address - Fax:
Practice Address - Street 1:5700 ACKERFIELD AVE APT 210
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-4975
Practice Address - Country:US
Practice Address - Phone:562-499-9314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA270234164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse