Provider Demographics
NPI:1730958893
Name:SHIREY, LANA M (ODA)
Entity type:Individual
Prefix:
First Name:LANA
Middle Name:M
Last Name:SHIREY
Suffix:
Gender:F
Credentials:ODA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12824 ROAD 21L
Mailing Address - Street 2:
Mailing Address - City:CLOVERDALE
Mailing Address - State:OH
Mailing Address - Zip Code:45827-9749
Mailing Address - Country:US
Mailing Address - Phone:419-890-7763
Mailing Address - Fax:
Practice Address - Street 1:12824 ROAD 21L
Practice Address - Street 2:
Practice Address - City:CLOVERDALE
Practice Address - State:OH
Practice Address - Zip Code:45827-9749
Practice Address - Country:US
Practice Address - Phone:419-890-7763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker