Provider Demographics
NPI:1720207772
Name:SHOCKLEY, LAURIE (CFA)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:SHOCKLEY
Suffix:
Gender:F
Credentials:CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 BURTON LN
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-4989
Mailing Address - Country:US
Mailing Address - Phone:931-260-4919
Mailing Address - Fax:888-329-6432
Practice Address - Street 1:551 BURTON LN
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38506-4989
Practice Address - Country:US
Practice Address - Phone:931-260-4919
Practice Address - Fax:888-329-6432
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist