Individual
LYDIA WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2307 GORDON COOPER DR, SHAWNEE, OK 74801-9007
(405) 214-5111
Mailing address
2307 GORDON COOPER DR, SHAWNEE, OK 74801-9007
(405) 287-8535
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
37V124914052
OK
Other
Enumeration date
08/07/2025
Last updated
08/07/2025
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