Provider Demographics
NPI:1568806701
Name:IRVIN-BROOKS, SHANEQUA LEANNA (LPN)
Entity Type:Individual
Prefix:
First Name:SHANEQUA
Middle Name:LEANNA
Last Name:IRVIN-BROOKS
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 1:5303 NORTHFIELD RD APT 219
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-1114
Mailing Address - Country:US
Mailing Address - Phone:216-217-8312
Mailing Address - Fax:
Practice Address - Street 1:5303 NORTHFIELD RD APT 219
Practice Address - Street 2:
Practice Address - City:BEDFORD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44146-1114
Practice Address - Country:US
Practice Address - Phone:216-217-8312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH152653164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse