Provider Demographics
NPI:1053126961
Name:HOLLMANN, SHAYLA MARIE
Entity type:Individual
Prefix:
First Name:SHAYLA
Middle Name:MARIE
Last Name:HOLLMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHAYLA
Other - Middle Name:MARIE
Other - Last Name:BLACKWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 S PALM ST
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-6016
Mailing Address - Country:US
Mailing Address - Phone:580-304-3528
Mailing Address - Fax:
Practice Address - Street 1:401 S PALM ST
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-6016
Practice Address - Country:US
Practice Address - Phone:580-304-3528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-08
Last Update Date:2025-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty