Provider Demographics
NPI:1053735522
Name:OVERTON, SHAWNDA POOL (LPN)
Entity type:Individual
Prefix:
First Name:SHAWNDA
Middle Name:POOL
Last Name:OVERTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7723 AVERETTE FIELD DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-5156
Mailing Address - Country:US
Mailing Address - Phone:919-449-8182
Mailing Address - Fax:
Practice Address - Street 1:7723 AVERETTE FIELD DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-5156
Practice Address - Country:US
Practice Address - Phone:919-449-8182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-04
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC063964164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse