Provider Demographics
NPI:1134513096
Name:PAYTON, SHALESE DAWN (RN)
Entity Type:Individual
Prefix:
First Name:SHALESE
Middle Name:DAWN
Last Name:PAYTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SHALESE
Other - Middle Name:DAWN
Other - Last Name:BOTTOMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2009 IMPERIAL DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-2928
Mailing Address - Country:US
Mailing Address - Phone:970-420-0616
Mailing Address - Fax:
Practice Address - Street 1:600 SOUTH DRIVE
Practice Address - Street 2:HARTSHORN HEALTH BUILDING
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521
Practice Address - Country:US
Practice Address - Phone:970-491-7121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0181996163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse