Provider Demographics
NPI:1952889321
Name:SHALOW, JEANELLE
Entity Type:Individual
Prefix:
First Name:JEANELLE
Middle Name:
Last Name:SHALOW
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 1:11929 UNIVERSITY BLVD STE 2M
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4757
Mailing Address - Country:US
Mailing Address - Phone:281-238-8775
Mailing Address - Fax:
Practice Address - Street 1:119 LAZY LN APT A
Practice Address - Street 2:
Practice Address - City:SEALY
Practice Address - State:TX
Practice Address - Zip Code:77474-3535
Practice Address - Country:US
Practice Address - Phone:281-845-1387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-29
Last Update Date:2018-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206207164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX206207OtherTEXAS BOARD OF NURSING