Provider Demographics
NPI:1043093867
Name:SHUCK, CHLOE GRACE
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:GRACE
Last Name:SHUCK
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 1:8601 S MINGO RD APT 7301
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4648
Mailing Address - Country:US
Mailing Address - Phone:307-331-0130
Mailing Address - Fax:
Practice Address - Street 1:8601 S MINGO RD APT 7301
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4648
Practice Address - Country:US
Practice Address - Phone:307-331-0130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program