Individual
CONNOR BUSHYHEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1420 N HARRISON AVE, SHAWNEE, OK 74801-5208
(405) 424-7711
Mailing address
1108 SKYVIEW DR, EL RENO, OK 73036-2026
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L0066904
OK
Other
Enumeration date
03/21/2024
Last updated
03/21/2024
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