Individual
MICHELLE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
781 GRAND CASINO BLVD, SHAWNEE, OK 74804-1005
(405) 964-5770
Mailing address
781 GRAND CASINO BLVD, SHAWNEE, OK 74804-1005
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
61920
OK
Other
Enumeration date
03/20/2015
Last updated
03/20/2015
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