Individual
MS. SHANEKA M HURDLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1011 HUFFINE MILL RD, GREENSBORO, NC 27405-6239
(336) 486-2562
Mailing address
1011 HUFFINE MILL RD, GREENSBORO, NC 27405-6239
(336) 486-2562
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
85936
NC
261QP2300X
Primary Care Clinic/Center
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1265066815
—
NC
Enumeration date
02/22/2020
Last updated
10/31/2020
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