Provider Demographics
NPI:1821706458
Name:DRAGS WOLF, SHALON
Entity Type:Individual
Prefix:
First Name:SHALON
Middle Name:
Last Name:DRAGS WOLF
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:PO BOX 12898
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87195-0898
Mailing Address - Country:US
Mailing Address - Phone:505-850-4921
Mailing Address - Fax:505-859-4214
Practice Address - Street 1:11005 SPAIN RD NE STE 15
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-1871
Practice Address - Country:US
Practice Address - Phone:505-850-4921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist