Individual
MS. GINNY REBECCA MASHBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
200 WHITE EAGLE DR, PONCA CITY, OK 74601
(580) 765-2501
(580) 765-7289
Mailing address
705 NORTH ELM, PONCO CITY, OK 74601
(580) 762-3298
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L0044597
OK
Other
Enumeration date
09/21/2006
Last updated
07/08/2007
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