Individual
JEANINE DIANNE DETERDING
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
306 FAIRVIEW AVE, PONCA CITY, OK 74601-2001
(580) 762-3342
(580) 762-5841
Mailing address
306 FAIRVIEW AVE, PONCA CITY, OK 74601-2001
(580) 762-3342
(580) 762-5841
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
R0045604
OK
Other
Enumeration date
07/13/2005
Last updated
07/08/2007
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