Individual
SHANNON RENAE SOMERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
104 S 4TH ST, PONCA CITY, OK 74601-5329
(580) 382-4034
Mailing address
104 S 4TH ST, PONCA CITY, OK 74601-5329
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R0128161
OK
363L00000X
Nurse Practitioner
Primary
211628
OK
Other
Enumeration date
09/07/2022
Last updated
01/31/2023
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