Individual
MAIDA DEE VANDUSER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
905 E WILSON ST, SHAWNEE, OK 74804-4165
(405) 878-7400
Mailing address
110 E MAIN ST, TECUMSEH, OK 74873-4234
(405) 371-0417
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
07/29/2013
Last updated
07/29/2013
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