Provider Demographics
NPI:1689818072
Name:HIGGINS, SHANI (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SHANI
Middle Name:
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:SHANI
Other - Middle Name:
Other - Last Name:SAMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1235 AMHERST PL
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-5033
Mailing Address - Country:US
Mailing Address - Phone:937-723-7695
Mailing Address - Fax:
Practice Address - Street 1:1235 AMHERST PL
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-5033
Practice Address - Country:US
Practice Address - Phone:937-723-7695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN111939164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse