Individual
SHANNON D KRUEGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
430 N MONTE VISTA ST, ADA, OK 74820-4610
(580) 421-1511
Mailing address
430 N MONTE VISTA ST, ADA, OK 74820-4610
(580) 421-1511
Taxonomy
Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
Primary
754947
TX
Other
Enumeration date
08/05/2019
Last updated
08/05/2019
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