Individual
SHAQUIRAH LASHEA SCREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
925 S WEST ST # ATB, BAINBRIDGE, GA 39819-4519
(229) 205-5032
Mailing address
925 S WEST ST APT B, BAINBRIDGE, GA 39819-4530
(229) 205-5032
Taxonomy
Speciality
Code
Description
License number
State
374T00000X
Religious Nonmedical Nursing Personnel
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
049851617
DL
GA
01
—
059851617
ID
GA
Enumeration date
02/20/2021
Last updated
04/15/2021
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