Individual
RYIAN CRENSHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
410 FAIRVIEW AVE, PONCA CITY, OK 74601-1922
(580) 749-4227
Mailing address
410 FAIRVIEW AVE, PONCA CITY, OK 74601-1922
(580) 749-4227
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
1069
OK
Other
Enumeration date
04/10/2015
Last updated
03/30/2021
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