Provider Demographics
NPI:1811401482
Name:SHAW, LATASHA (LVN)
Entity Type:Individual
Prefix:
First Name:LATASHA
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 SPARTANS DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313-5449
Mailing Address - Country:US
Mailing Address - Phone:661-912-7169
Mailing Address - Fax:
Practice Address - Street 1:1014 CALLOWAY DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-6337
Practice Address - Country:US
Practice Address - Phone:661-630-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA290342164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse