Provider Demographics
NPI:1851913461
Name:MORGAN, SHAVUNDA IRENE
Entity Type:Individual
Prefix:
First Name:SHAVUNDA
Middle Name:IRENE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14445 WILLSCOTT DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-6907
Mailing Address - Country:US
Mailing Address - Phone:903-283-7002
Mailing Address - Fax:
Practice Address - Street 1:14445 WILLSCOTT DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-6907
Practice Address - Country:US
Practice Address - Phone:903-283-7002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX305325164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse