Individual
MAI A LE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2307 GORDON COOPER DR, SHAWNEE, OK 74801-9007
(405) 273-5236
Mailing address
2307 GORDON COOPER DR, SHAWNEE, OK 74801-9007
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
65625
OK
Other
Enumeration date
09/13/2018
Last updated
09/13/2018
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