Provider Demographics
NPI:1356133045
Name:IBEGBU, SHANCIE (RN, LVN)
Entity type:Individual
Prefix:
First Name:SHANCIE
Middle Name:
Last Name:IBEGBU
Suffix:
Gender:F
Credentials:RN, LVN
Other - Prefix:
Other - First Name:SHANCIE
Other - Middle Name:
Other - Last Name:MIMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN,LVN
Mailing Address - Street 1:1901 KIT FOX RUN
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75181-4328
Mailing Address - Country:US
Mailing Address - Phone:469-583-3388
Mailing Address - Fax:
Practice Address - Street 1:1901 KIT FOX RUN
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75181-4328
Practice Address - Country:US
Practice Address - Phone:469-583-3388
Practice Address - Fax:469-583-3388
Is Sole Proprietor?:No
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1068165163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care