Provider Demographics
NPI:1134720832
Name:HARDWICK-MOSES, SHELINA (LPN)
Entity type:Individual
Prefix:
First Name:SHELINA
Middle Name:
Last Name:HARDWICK-MOSES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1391 FROST ST
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CA
Mailing Address - Zip Code:93523-2715
Mailing Address - Country:US
Mailing Address - Phone:985-750-8237
Mailing Address - Fax:
Practice Address - Street 1:1391 FROST ST
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CA
Practice Address - Zip Code:93523-2715
Practice Address - Country:US
Practice Address - Phone:985-750-8237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-08
Last Update Date:2020-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002100219164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse