Provider Demographics
NPI:1750547816
Name:MARTIN, SHAWNA DANETTE (BA)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:DANETTE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:SHAWNA
Other - Middle Name:DANETTE
Other - Last Name:OLIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:26243 HIGHWAY 51
Mailing Address - Street 2:
Mailing Address - City:WAGONER
Mailing Address - State:OK
Mailing Address - Zip Code:74467-8740
Mailing Address - Country:US
Mailing Address - Phone:918-935-7668
Mailing Address - Fax:
Practice Address - Street 1:26243 HIGHWAY 51
Practice Address - Street 2:
Practice Address - City:WAGONER
Practice Address - State:OK
Practice Address - Zip Code:74467-8740
Practice Address - Country:US
Practice Address - Phone:918-935-7668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator