Provider Demographics
NPI:1902578131
Name:SHAULL, HAILEY GRACE (PA-C)
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:GRACE
Last Name:SHAULL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4444 W 76TH ST
Mailing Address - Street 2:STE 400
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5178
Mailing Address - Country:US
Mailing Address - Phone:608-931-7557
Mailing Address - Fax:
Practice Address - Street 1:4444 W 76TH ST STE 400
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5178
Practice Address - Country:US
Practice Address - Phone:612-746-7347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2022-06-09
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant