| Doctor Name: | SHANA HARTLEY |
| NPI Number: | 1275886194 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN, IBCLC |
| License Number: | 75871 |
| Business Practice Address: | 803 N Foreman St Suite 102 Vinita, OK - 743011435 |
| Business Phone Number: | 9182562261 |
| Business Fax Number: | 9182562304 |
| Mailing Address: | 803 N Foreman St, Suite 102 VINITA |
| State: | OK |
| Postal Code: | 743011435 |
| Phone Number: | 9182562261 |
| Fax Number: | 9182562304 |
| NPI Enumeration Date: | 10/16/2012 |
| NPI Last Update Date: | 10/16/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WL0100X |
| License Number: | 75871 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Lactation Consultant |
| Taxonomy Definition: | |