Individual
LYEA DORAE SHINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
502 MCCURRY ST, PLEASANT HOPE, MO 65725-9231
(904) 254-3686
Mailing address
PO BOX 68, FAYETTEVILLE, NY 13066-0068
(904) 254-3686
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2014029095
MO
367500000X
Certified Registered Nurse Anesthetist
Primary
811313
NY
Other
Enumeration date
11/03/2020
Last updated
06/01/2021
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