Provider Demographics
NPI:1811068240
Name:SCHEEVAL, SALLY ANN (LPN)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:ANN
Last Name:SCHEEVAL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:ANN
Other - Last Name:ELLIOTT STIEGLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:PO BOX 385
Mailing Address - Street 2:
Mailing Address - City:LAPWAI
Mailing Address - State:ID
Mailing Address - Zip Code:83540-0385
Mailing Address - Country:US
Mailing Address - Phone:208-843-2271
Mailing Address - Fax:208-843-2658
Practice Address - Street 1:111 BEVER GRADE
Practice Address - Street 2:
Practice Address - City:LAPWAI
Practice Address - State:ID
Practice Address - Zip Code:83540
Practice Address - Country:US
Practice Address - Phone:208-843-2271
Practice Address - Fax:208-843-2658
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLPN 27734164W00000X
MNL0530978164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered164W00000XNursing Service ProvidersLicensed Practical Nurse