Individual
SHAWNTAY LATRICE FORREST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.N
Contact information
Practice address
109 BEE ST, CHARLESTON, SC 29401-5703
(843) 870-1315
Mailing address
5751 SCOTT WHITE RD, HOLLYWOOD, SC 29449-6156
(843) 870-1315
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
P 40923
SC
Other
Enumeration date
06/22/2008
Last updated
06/22/2008
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