Individual
GWENDOLYN STEWARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
101 S MOORE AVE, CLAREMORE, OK 74017-5047
(918) 342-6200
Mailing address
101 S MOORE AVE, CLAREMORE, OK 74017-5047
(918) 342-6200
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
41554
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
41554
LPN LICENSE
OK
Enumeration date
10/09/2007
Last updated
10/09/2007
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