Provider Demographics
NPI:1841551413
Name:WHITLEY, SHAINA DANAE (LPN)
Entity type:Individual
Prefix:
First Name:SHAINA
Middle Name:DANAE
Last Name:WHITLEY
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 1:820 GRIMES BLVD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27292-7640
Mailing Address - Country:US
Mailing Address - Phone:336-224-6070
Mailing Address - Fax:336-224-6393
Practice Address - Street 1:820 GRIMES BLVD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-7640
Practice Address - Country:US
Practice Address - Phone:336-224-6070
Practice Address - Fax:336-224-6393
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC76445164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse