Individual
SHELLEY WAGGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6333 E SKELLY DR, TULSA, OK 74135-6106
(918) 633-2442
Mailing address
6727 S 73RD EAST AVE, TULSA, OK 74133-1832
(918) 734-5866
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
03/16/2013
Last updated
03/16/2013
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