Individual
ANGELA M SHUPERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
511 E 2ND ST, HEAVENER, OK 74937-3419
(918) 653-7718
Mailing address
20361 PINE MTN LOOP, HEAVENER, OK 74937-3679
(918) 658-4149
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
0112203
OK
Other
Enumeration date
12/09/2022
Last updated
12/09/2022
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