Provider Demographics
NPI:1023301546
Name:FRIERSON, SHAWNA NICOLE
Entity type:Individual
Prefix:MISS
First Name:SHAWNA
Middle Name:NICOLE
Last Name:FRIERSON
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 1:3818 CHESTERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MOHEGAN LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:10547-1006
Mailing Address - Country:US
Mailing Address - Phone:914-528-5893
Mailing Address - Fax:
Practice Address - Street 1:3818 CHESTERFIELD DR
Practice Address - Street 2:
Practice Address - City:MOHEGAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:10547-1006
Practice Address - Country:US
Practice Address - Phone:914-528-5893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY279032164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse