Provider Demographics
NPI:1942792478
Name:STANPHILL, SHANNON ROSE (LVN)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:ROSE
Last Name:STANPHILL
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 1:369 SANDY MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:SUNRISE BEACH
Mailing Address - State:TX
Mailing Address - Zip Code:78643-9262
Mailing Address - Country:US
Mailing Address - Phone:830-265-0986
Mailing Address - Fax:
Practice Address - Street 1:369 SANDY MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:SUNRISE BEACH
Practice Address - State:TX
Practice Address - Zip Code:78643-9262
Practice Address - Country:US
Practice Address - Phone:830-265-0986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX184897164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse