Provider Demographics
NPI:1831657451
Name:ESTRIDGE, SHANNA LYNN (LVN)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:LYNN
Last Name:ESTRIDGE
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:PO BOX 431
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:TX
Mailing Address - Zip Code:76374-0431
Mailing Address - Country:US
Mailing Address - Phone:940-250-9758
Mailing Address - Fax:
Practice Address - Street 1:112 W OAK ST
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:TX
Practice Address - Zip Code:76374-1532
Practice Address - Country:US
Practice Address - Phone:940-250-9758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332853164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse