Provider Demographics
NPI:1487139655
Name:MCGILL, CAITLIN SHANNON (LVN)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:SHANNON
Last Name:MCGILL
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13515 W COUNTY ROAD 123
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-8802
Mailing Address - Country:US
Mailing Address - Phone:432-208-4283
Mailing Address - Fax:
Practice Address - Street 1:13515 W COUNTY ROAD 123
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79765-8802
Practice Address - Country:US
Practice Address - Phone:432-208-4283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX345071164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse