Provider Demographics
NPI:1568874717
Name:HALL, SHELLEY DAWN
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:DAWN
Last Name:HALL
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 1:2222 BROOK DR
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-7249
Mailing Address - Country:US
Mailing Address - Phone:405-589-9592
Mailing Address - Fax:405-424-4962
Practice Address - Street 1:2222 BROOK DR
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-7249
Practice Address - Country:US
Practice Address - Phone:405-589-9592
Practice Address - Fax:405-424-4962
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK88683163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse