Individual
SUZZIE J WALDENVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
401 NW H ST, STIGLER, OK 74462-1625
(918) 967-4682
(918) 967-8694
Mailing address
401 NW H ST, P.O. BOX 728, STIGLER, OK 74462-1625
(918) 967-4682
(918) 967-8694
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
627
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100716300B
—
OK
Enumeration date
01/03/2007
Last updated
04/30/2009
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