Provider Demographics
NPI:1972004331
Name:SHABAZZ, NELSALINA DEBORAH (LVN)
Entity Type:Individual
Prefix:
First Name:NELSALINA
Middle Name:DEBORAH
Last Name:SHABAZZ
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 1:4200 ROCK LAKE DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313-5032
Mailing Address - Country:US
Mailing Address - Phone:323-632-4370
Mailing Address - Fax:
Practice Address - Street 1:2815 FLINT HILLS DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93313-5742
Practice Address - Country:US
Practice Address - Phone:323-632-4370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
157206943310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility