1346514551 NPI number — MISS SHIANE DANIELLE SHELTON BA, BHRS

Table of content: MISS SHIANE DANIELLE SHELTON BA, BHRS (NPI 1346514551)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346514551 NPI number — MISS SHIANE DANIELLE SHELTON BA, BHRS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHELTON
Provider First Name:
SHIANE
Provider Middle Name:
DANIELLE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
BA, BHRS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346514551
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17 S CENTRAL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IDABEL
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74745-4625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-286-5184
Provider Business Mailing Address Fax Number:
580-286-5185

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 S CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IDABEL
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74745-4625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-286-5184
Provider Business Practice Location Address Fax Number:
580-286-5185
Provider Enumeration Date:
03/06/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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