Provider Demographics
NPI:1629282942
Name:CHANEY, SHAWNTA DELORES (LPN)
Entity Type:Individual
Prefix:
First Name:SHAWNTA
Middle Name:DELORES
Last Name:CHANEY
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 1:26659 TOWNSHIP ROAD 31
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:OH
Mailing Address - Zip Code:43844-9314
Mailing Address - Country:US
Mailing Address - Phone:740-824-3272
Mailing Address - Fax:
Practice Address - Street 1:26659 TOWNSHIP ROAD 31
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:OH
Practice Address - Zip Code:43844-9314
Practice Address - Country:US
Practice Address - Phone:740-824-3272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN108971164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2270000Medicaid