Individual
ASHLEY DAWN SOURJOHN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
206 E BLUE STARR DR, CLAREMORE, OK 74017-4223
(918) 341-8100
(918) 341-8139
Mailing address
206 E BLUE STARR DR, CLAREMORE, OK 74017-4223
(918) 341-8100
(918) 341-8139
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
F07201695
OK
Other
Enumeration date
08/13/2020
Last updated
08/13/2020
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