Provider Demographics
NPI:1881943991
Name:GARRETT, IEAISHA SHAVETTE
Entity type:Individual
Prefix:
First Name:IEAISHA
Middle Name:SHAVETTE
Last Name:GARRETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 VERMONT
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75134
Mailing Address - Country:US
Mailing Address - Phone:757-576-2962
Mailing Address - Fax:
Practice Address - Street 1:1406 VERMONT
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75134
Practice Address - Country:US
Practice Address - Phone:757-576-2962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3747A0650X3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider