Provider Demographics
NPI:1942757067
Name:BLUEBIRD, DENA SHAWN
Entity Type:Individual
Prefix:MRS
First Name:DENA
Middle Name:SHAWN
Last Name:BLUEBIRD
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 1:1325 E BOONE ST
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-3361
Mailing Address - Country:US
Mailing Address - Phone:918-207-4977
Mailing Address - Fax:918-458-6167
Practice Address - Street 1:1325 E BOONE ST
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-3361
Practice Address - Country:US
Practice Address - Phone:918-207-4977
Practice Address - Fax:918-458-6167
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator