Gilliam, Shasta Dawn

Gilliam, Shasta Dawn is an individual health care provider with primary practice located at 1614 S Kanawha St , Beckley WV 25801-6239. She recently has only one registered license in Nursing Service Related Providers / Homemaker, which is considered as her primary health care specialty. Gilliam, Shasta Dawn can be contacted via phone (304) 255-1397.

Contact Information

Primary practice address
1614 S Kanawha St Beckley WV 25801-6239
Phone: (304) 255-1397
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Related Providers / Homemaker 376J00000X

Profile Details

NPI number 1497354211
LBN Legal business name Gilliam, Shasta Dawn
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 22nd, 2020
Last updated Oct 22nd, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1497354211 NPPES
West Virginia MEDICAID 1083825038
West Virginia MEDICAID 1104037019
West Virginia MEDICAID 1619185147

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