Provider Demographics
NPI:1992233134
Name:SHIRAH, HALEY BROOKE (LPN)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:BROOKE
Last Name:SHIRAH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 689
Mailing Address - Street 2:
Mailing Address - City:CALERA
Mailing Address - State:AL
Mailing Address - Zip Code:35040-0689
Mailing Address - Country:US
Mailing Address - Phone:205-755-8800
Mailing Address - Fax:
Practice Address - Street 1:110 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:CLANTON
Practice Address - State:AL
Practice Address - Zip Code:35045-2332
Practice Address - Country:US
Practice Address - Phone:205-755-5933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2-065953164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse