Provider Demographics
NPI:1154122737
Name:VANHART, SHANNON LEE
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEE
Last Name:VANHART
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 NE KINGSBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73507-1917
Mailing Address - Country:US
Mailing Address - Phone:307-757-5407
Mailing Address - Fax:
Practice Address - Street 1:3010 NE KINGSBRIAR DR
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73507-1917
Practice Address - Country:US
Practice Address - Phone:307-757-5407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist