Provider Demographics
NPI:1942821608
Name:ROLFS, SHANNA LYNNE
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:LYNNE
Last Name:ROLFS
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 1:1825 MISSION RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6580
Mailing Address - Country:US
Mailing Address - Phone:405-513-3746
Mailing Address - Fax:
Practice Address - Street 1:1825 MISSION RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6580
Practice Address - Country:US
Practice Address - Phone:405-513-3746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program