Individual
MS. SHONDA RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1095 S. NICKERSON ST., WAYNOKA, OK 73860
(580) 824-0674
Mailing address
20138 COUNTRY ROAD. 280, WAYNOKA, OK 73860
(580) 273-9631
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
03/16/2018
Last updated
03/16/2018
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