Provider Demographics
NPI:1598426611
Name:VICK, SHAMONIA WRIGHT (LPN)
Entity Type:Individual
Prefix:
First Name:SHAMONIA
Middle Name:WRIGHT
Last Name:VICK
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 1:146 MASSEY RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27866-9653
Mailing Address - Country:US
Mailing Address - Phone:252-676-2093
Mailing Address - Fax:
Practice Address - Street 1:146 MASSEY RD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:NC
Practice Address - Zip Code:27866-9653
Practice Address - Country:US
Practice Address - Phone:252-676-2093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-02
Last Update Date:2022-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC74919164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse