Individual
MRS. AMANDA ROSE GRESHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
101 N UNION AVE, SHAWNEE, OK 74801-7067
(405) 275-7100
Mailing address
101 N UNION AVE, SHAWNEE, OK 74801-7067
(405) 275-7100
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
12/13/2019
Last updated
12/13/2019
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