Individual
SHANE WADE HENLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1624 CIMARRON PLZ, STILLWATER, OK 74075-3467
(844) 458-2100
Mailing address
1504 SHIRLEE AVE, PONCA CITY, OK 74604-1423
(405) 332-3128
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
10/03/2023
Last updated
12/30/2023
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