Individual
IAONG LOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
607 S BROADWAY, COWETA, OK 74429-5000
(918) 486-5564
Mailing address
607 S BROADWAY, COWETA, OK 74429-5000
(918) 486-5564
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
224002
OK
Other
Enumeration date
09/17/2024
Last updated
01/28/2026
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