Shadell Danae Maria Womack III

Primary specialty

Licensed Vocational NurseTaxonomy code 164X00000X

License

717412 Issued in CA

Practice address

301 E 13TH St Ste D
Merced, CA 95341-6211

Phone

(209) 386-1096

NPI assigned

Apr 20, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Shadell Danae Maria Nichols Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Medmark Treatment Centers - Stockton, Inc.

  • Methadone Clinic
  • Stockton, CA
  • NPI 1851453500
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1618876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702339200000",
    "number": "1992386973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 N EL DORADO ST",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952021305",
            "telephone_number": "209-938-0228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 E 13TH ST STE D",
            "city": "MERCED",
            "state": "CA",
            "postal_code": "953416211",
            "telephone_number": "209-386-1096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOMACK",
        "first_name": "SHADELL",
        "middle_name": "DANAE MARIA",
        "name_suffix": "III",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-20",
        "last_updated": "2023-12-12",
        "certification_date": "2023-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "717412",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "00000000",
            "identifier": "0000000",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHADELL",
            "last_name": "NICHOLS",
            "middle_name": "DANAE MARIA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Marilyn Wilson
• Tarah Laniece Wilson, LVN
• Pearl Wise
• Lisa Ann Wiseman, LVN
• Laura Grey Wolf, AU.D.
• Peter Lap Wong, MD
• Hansa Wongprasert, M.D.
• Jonathan Wongsavanh, DO
• Rebeca Wood
• Petronila N Woods

• Licensed Vocational Nurse in Merced, CA
• Providers in Merced, CA by specialty
• Licensed Vocational Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.