Provider Demographics
NPI:1780064865
Name:HALE, SHAREN DEE (LPT)
Entity type:Individual
Prefix:
First Name:SHAREN
Middle Name:DEE
Last Name:HALE
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 HIGOS WAY
Mailing Address - Street 2:
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-9126
Mailing Address - Country:US
Mailing Address - Phone:805-709-3366
Mailing Address - Fax:
Practice Address - Street 1:518 HIGOS WAY
Practice Address - Street 2:
Practice Address - City:NIPOMO
Practice Address - State:CA
Practice Address - Zip Code:93444-9126
Practice Address - Country:US
Practice Address - Phone:805-709-3366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 36410247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other