Individual
MS. VANECIA T SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
5525 MIRIAM RD, PHILADELPHIA, PA 19124-1715
(215) 237-1958
Mailing address
5525 MIRIAM RD, PHILADELPHIA, PA 19124-1715
(215) 237-1958
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN286676
PA
Other
Enumeration date
02/08/2017
Last updated
02/08/2017
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