Individual
TEOLA M WALLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2307 S. GORDON COOPER DR., SHAWNEE, OK 74801
(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
68780
OK
Other
Enumeration date
08/08/2018
Last updated
08/08/2018
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