Provider Demographics
NPI:1801568191
Name:SHAW, LAPRECE (STNA/LPN)
Entity type:Individual
Prefix:MS
First Name:LAPRECE
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:STNA/LPN
Other - Prefix:
Other - First Name:LAPRECE
Other - Middle Name:MYCA
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 RAVINE PARK VLG
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43605-4905
Mailing Address - Country:US
Mailing Address - Phone:419-984-6982
Mailing Address - Fax:
Practice Address - Street 1:5981 MARVIN ST
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-1188
Practice Address - Country:US
Practice Address - Phone:419-984-6982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH32222191440512251J00000X
MI230014192390608376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No251J00000XAgenciesNursing Care