Provider Demographics
NPI:1962032136
Name:CARSON-CHANDLER, SHANAURIE MARIE (LVN)
Entity Type:Individual
Prefix:
First Name:SHANAURIE
Middle Name:MARIE
Last Name:CARSON-CHANDLER
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 1:7616 UPPER SEGUIN RD TRLR 94
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-9799
Mailing Address - Country:US
Mailing Address - Phone:210-330-0443
Mailing Address - Fax:
Practice Address - Street 1:7616 UPPER SEGUIN RD TRLR 94
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-9799
Practice Address - Country:US
Practice Address - Phone:210-330-0443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX331151164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse