Individual
MARY NEVAQUAYA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1515 NE LAWRIE TATUM RD, LAWTON, OK 73507-3002
(580) 354-5315
Mailing address
2705 SE 75TH ST, LAWTON, OK 73501-9464
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
53159
OK
Other
Enumeration date
11/04/2015
Last updated
11/04/2015
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