Provider Demographics
NPI:1366942021
Name:HICKERSON, LASHUNDA SHANTEL
Entity type:Individual
Prefix:
First Name:LASHUNDA
Middle Name:SHANTEL
Last Name:HICKERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4438 KIRK MANOR CT
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-6054
Mailing Address - Country:US
Mailing Address - Phone:713-582-9747
Mailing Address - Fax:281-710-4712
Practice Address - Street 1:4438 KIRK MANOR CT
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:TX
Practice Address - Zip Code:77545-6054
Practice Address - Country:US
Practice Address - Phone:713-582-9747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX938503163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse