Provider Demographics
NPI:1700053915
Name:STOREY, SHAUNA (LPN)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:STOREY
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 1:13 RED OAK PL
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-6805
Mailing Address - Country:US
Mailing Address - Phone:501-240-4623
Mailing Address - Fax:501-978-1127
Practice Address - Street 1:13 RED OAK PL
Practice Address - Street 2:
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113-6805
Practice Address - Country:US
Practice Address - Phone:501-240-4623
Practice Address - Fax:501-978-1127
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL44581164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse