Organization
DAGENAIS & ASSOCIATES MEDICAL CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY JANE DAGENAIS PA (OWNER)
(918) 217-8696
Entity
Organization
Contact information
Practice address
137 EAST MAIN, PAWHUSKA, OK 74056
(918) 217-8696
(918) 217-8696
Mailing address
539 LEAHY AVE, PAWHUSKA, OK 74056-5241
(918) 217-8696
(918) 217-8696
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1218
OK
Other
Enumeration date
12/16/2014
Last updated
03/23/2020
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