Provider Demographics
NPI:1760177539
Name:SMITH-HAYES, SHANTIQUE SHANEE
Entity Type:Individual
Prefix:
First Name:SHANTIQUE
Middle Name:SHANEE
Last Name:SMITH-HAYES
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 1:6915 W GLENBROOK RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-1111
Mailing Address - Country:US
Mailing Address - Phone:262-565-7822
Mailing Address - Fax:
Practice Address - Street 1:6915 W GLENBROOK RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-1111
Practice Address - Country:US
Practice Address - Phone:262-565-7822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula