Individual
MRS. ZONDRA MAGNESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
RT.1 BOX 35D, BOLEY, OK 74829
(918) 667-3367
(918) 667-3651
Mailing address
PO BOX 218, BOLEY, OK 74829-0218
(918) 667-3367
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100685600D
—
OK
05
—
1006856600A
—
OK
Enumeration date
06/03/2016
Last updated
06/03/2016
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