Individual
SANDRA SHOMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
100 S BLISS AVE, TAHLEQUAH, OK 74464-2512
(918) 453-5000
Mailing address
100 S BLISS AVE, TAHLEQUAH, OK 74464-2512
(918) 453-5000
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
60291
OK
Other
Enumeration date
01/19/2017
Last updated
01/19/2017
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