Provider Demographics
NPI:1841665023
Name:SALAZAR, SHAWNA (LPN)
Entity type:Individual
Prefix:MRS
First Name:SHAWNA
Middle Name:
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:SHAWNA
Other - Middle Name:
Other - Last Name:SALAZAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:6844 MALOUFF RD
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-9739
Mailing Address - Country:US
Mailing Address - Phone:719-480-3094
Mailing Address - Fax:
Practice Address - Street 1:8745 COUNTY ROAD 9 S
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-9610
Practice Address - Country:US
Practice Address - Phone:719-587-6944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPN0330935164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse