Provider Demographics
NPI:1003510637
Name:MILES, SHAWNTOREA LACHELLE
Entity Type:Individual
Prefix:MS
First Name:SHAWNTOREA
Middle Name:LACHELLE
Last Name:MILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12017 SW 1ST ST
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6898
Mailing Address - Country:US
Mailing Address - Phone:405-514-5753
Mailing Address - Fax:
Practice Address - Street 1:7901 NE 10TH ST STE B101
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-3653
Practice Address - Country:US
Practice Address - Phone:405-514-5753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula