Healthcare Provider Details

I. General information

NPI: 1730003500
Provider Name (Legal Business Name): SHANNON DALE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8511 TIMBERWOOD LN
HAUGHTON LA
71037-9377
US

IV. Provider business mailing address

8511 TIMBERWOOD LN
HAUGHTON LA
71037-9377
US

V. Phone/Fax

Practice location:
  • Phone: 318-935-1900
  • Fax:
Mailing address:
  • Phone: 318-935-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN123119
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: