Individual
SHANNON LEAH NILES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
10121 CHERRY CREEK LN, PORT RICHEY, FL 34668-3709
(727) 647-9072
Mailing address
10121 CHERRY CREEK LN, PORT RICHEY, FL 34668-3709
(727) 647-9072
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
5222976
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5222976
LPN LICENSE
FL
Enumeration date
03/07/2019
Last updated
03/07/2019
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