Provider Demographics
NPI:1255817540
Name:WASHINGTON, SHIRLEY MARIE (CNA)
Entity type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:MARIE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3227 OLD MOORINGSPORT RD.
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107
Mailing Address - Country:US
Mailing Address - Phone:318-344-8700
Mailing Address - Fax:
Practice Address - Street 1:3227 OLD MOORINGSPORT RD.
Practice Address - Street 2:
Practice Address - City:SHREVEPORT RD
Practice Address - State:LA
Practice Address - Zip Code:71107
Practice Address - Country:US
Practice Address - Phone:318-344-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant