Individual
SHELBY DANE MENIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
300 W 5TH ST LOT 19, GORE, OK 74435-5377
(918) 348-4384
Mailing address
711 S MUSKOGEE AVE, TAHLEQUAH, OK 74464-4717
(918) 348-4384
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L0065513
OK
Other
Enumeration date
01/09/2024
Last updated
01/09/2024
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