Provider Demographics
NPI:1912381765
Name:HALL, SHA' QUAN
Entity Type:Individual
Prefix:
First Name:SHA' QUAN
Middle Name:
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 1:3205 WILLIAMSBURG ST
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1107
Mailing Address - Country:US
Mailing Address - Phone:405-501-1917
Mailing Address - Fax:
Practice Address - Street 1:3205 WILLIAMSBURG ST
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1107
Practice Address - Country:US
Practice Address - Phone:405-501-1917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor