Provider Demographics
NPI:1023321973
Name:SHEGOG, ERNESTINE (LVN)
Entity type:Individual
Prefix:
First Name:ERNESTINE
Middle Name:
Last Name:SHEGOG
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 1:4176 MISTY ELM CT
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-3304
Mailing Address - Country:US
Mailing Address - Phone:805-275-2074
Mailing Address - Fax:805-275-1616
Practice Address - Street 1:4176 MISTY ELM CT
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-3304
Practice Address - Country:US
Practice Address - Phone:805-275-2074
Practice Address - Fax:805-275-1616
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN137017164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse