Individual
ALISHA RANEE PENCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
448 36TH AVE NW STE 101, NORMAN, OK 73072-4743
Mailing address
9816 SW 89TH ST, MUSTANG, OK 73064-5214
(405) 448-0257
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000000
—
OK
Enumeration date
08/24/2017
Last updated
08/24/2017
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