Provider Demographics
NPI:1275886194
Name:HARTLEY, SHANA (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 N FOREMAN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301-1435
Mailing Address - Country:US
Mailing Address - Phone:918-256-2261
Mailing Address - Fax:918-256-2304
Practice Address - Street 1:803 N FOREMAN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-1435
Practice Address - Country:US
Practice Address - Phone:918-256-2261
Practice Address - Fax:918-256-2304
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK75871163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant