Individual
SHANNON DEE BROADIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
721 E GRAND AVE, PONCA CITY, OK 74601-5513
(580) 749-5139
Mailing address
721 E GRAND AVE, PONCA CITY, OK 74601-5513
(580) 749-5139
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R0085845
OK
Other
Enumeration date
01/28/2008
Last updated
03/04/2008
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