Individual
SHANNON DENISE IJAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1334 N LANSING AVE, TULSA, OK 74106-5907
(918) 587-2171
Mailing address
PO BOX 268838, OKLAHOMA CITY, OK 73126-8838
(918) 619-4600
(918) 619-4601
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
906
OK
Other
Enumeration date
01/05/2012
Last updated
01/05/2012
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