Provider Demographics
NPI:1942934823
Name:SHAMBLIN, LASHAWN
Entity Type:Individual
Prefix:
First Name:LASHAWN
Middle Name:
Last Name:SHAMBLIN
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 1:2366 55TH ST S APT 206
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-7625
Mailing Address - Country:US
Mailing Address - Phone:312-404-8184
Mailing Address - Fax:
Practice Address - Street 1:2366 55TH ST S APT 206
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7625
Practice Address - Country:US
Practice Address - Phone:312-404-8184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-15
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND0005879966Medicaid