Provider Demographics
NPI:1629618699
Name:SHOULDERS, TIMISHA (LPN)
Entity Type:Individual
Prefix:MS
First Name:TIMISHA
Middle Name:
Last Name:SHOULDERS
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 1:11037 QUAILRIDGE CT APT 7
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-4659
Mailing Address - Country:US
Mailing Address - Phone:513-238-9152
Mailing Address - Fax:
Practice Address - Street 1:11037 QUAILRIDGE CT APT 7
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-4659
Practice Address - Country:US
Practice Address - Phone:513-238-9152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH172617164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse