Provider Demographics
NPI:1508673146
Name:LAMOTTE - OSBORNE, SHAUNTRA (BCHHP, CHN)
Entity type:Individual
Prefix:
First Name:SHAUNTRA
Middle Name:
Last Name:LAMOTTE - OSBORNE
Suffix:
Gender:F
Credentials:BCHHP, CHN
Other - Prefix:MRS
Other - First Name:SHAUNTRA
Other - Middle Name:
Other - Last Name:OSBORNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCHHP, CHN
Mailing Address - Street 1:2232 DELL RANGE BLVD SUITE 245 BOX# 3317
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009
Mailing Address - Country:US
Mailing Address - Phone:973-517-0182
Mailing Address - Fax:
Practice Address - Street 1:2232 DELL RANGE BLVD SUITE 245 BOX# 3317
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009
Practice Address - Country:US
Practice Address - Phone:973-517-0182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
115535979133NN1002X, 133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education