Provider Demographics
NPI:1730672387
Name:MCGINNIS, SHAUNTEE EVETTE (LPN)
Entity Type:Individual
Prefix:
First Name:SHAUNTEE
Middle Name:EVETTE
Last Name:MCGINNIS
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 1:1741 RAINBOW PARK
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43206-1835
Mailing Address - Country:US
Mailing Address - Phone:614-288-7787
Mailing Address - Fax:
Practice Address - Street 1:1741 RAINBOW PARK
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43206-1835
Practice Address - Country:US
Practice Address - Phone:614-288-7787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH144073164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH144073OtherOHIO BOARD OF NURSING