Provider Demographics
NPI:1770186009
Name:STRONG, SHANIQUA (RN)
Entity Type:Individual
Prefix:
First Name:SHANIQUA
Middle Name:
Last Name:STRONG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 88
Mailing Address - Street 2:
Mailing Address - City:COURTLAND
Mailing Address - State:MS
Mailing Address - Zip Code:38620-0088
Mailing Address - Country:US
Mailing Address - Phone:662-934-4534
Mailing Address - Fax:
Practice Address - Street 1:1475 HADORN RD APT 29
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-5441
Practice Address - Country:US
Practice Address - Phone:662-934-4534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS913498163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS913498OtherNURSING LICENSE NUMBER