Individual
CONSTANCE RENE SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1300 SUMMERS PL, PONCA CITY, OK 74604-4443
(580) 761-2880
Mailing address
1300 SUMMERS PL, PONCA CITY, OK 74604-4443
(580) 761-2880
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
03/14/2018
Last updated
03/14/2018
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