Individual
SHANETTE NETINA FOWLKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2325 S HARVARD AVE, TULSA, OK 74114-3300
(918) 712-4301
Mailing address
6258 E 36TH ST, TULSA, OK 74135-5809
(918) 406-5914
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L0067608
OK
Other
Enumeration date
09/25/2024
Last updated
09/25/2024
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