Individual
ETHAN BIRDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1202 MONROE DR, SHAWNEE, OK 74804-4139
(405) 517-3806
Mailing address
1202 MONROE DR, SHAWNEE, OK 74804-4139
(405) 517-3806
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
OK
Other
Enumeration date
10/14/2022
Last updated
10/14/2022
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