Provider Demographics
NPI:1750014890
Name:MCINTOSH, SHALA (RN BSN IBCLC)
Entity type:Individual
Prefix:
First Name:SHALA
Middle Name:
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:RN BSN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 17TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-2448
Mailing Address - Country:US
Mailing Address - Phone:580-254-8654
Mailing Address - Fax:580-254-8660
Practice Address - Street 1:900 17TH ST
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-2448
Practice Address - Country:US
Practice Address - Phone:580-254-8654
Practice Address - Fax:580-254-8660
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0114498163W00000X
L-307395174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No163W00000XNursing Service ProvidersRegistered Nurse