Provider Demographics
NPI:1952865727
Name:HAYNER, SHALE CHRISTINE
Entity Type:Individual
Prefix:
First Name:SHALE
Middle Name:CHRISTINE
Last Name:HAYNER
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 1:1827 CEDAR VILLAGE CT
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-2989
Mailing Address - Country:US
Mailing Address - Phone:937-302-0797
Mailing Address - Fax:
Practice Address - Street 1:1827 CEDAR VILLAGE CT
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-2989
Practice Address - Country:US
Practice Address - Phone:937-302-0797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide