1679752430 NPI number — MRS. SHATON MONEEK COUNCIL LPN

Table of content: MRS. SHATON MONEEK COUNCIL LPN (NPI 1679752430)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679752430 NPI number — MRS. SHATON MONEEK COUNCIL LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COUNCIL
Provider First Name:
SHATON
Provider Middle Name:
MONEEK
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PYATT
Provider Other First Name:
SHATON
Provider Other Middle Name:
MONEEK
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1679752430
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5001 CYPRESS CREEK AVE E
Provider Second Line Business Mailing Address:
APT.1407
Provider Business Mailing Address City Name:
TUSCALOOSA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35405-6017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-633-8696
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5001 CYPRESS CREEK AVE E
Provider Second Line Business Practice Location Address:
APT.1407
Provider Business Practice Location Address City Name:
TUSCALOOSA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35405-6017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-633-8696
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164W00000X , with the licence number:  2047908 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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