Individual
LONNA BOUTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1904 N UNION ST, PONCA CITY, OK 74601-1542
(580) 541-4857
Mailing address
309 S 2ND ST, TONKAWA, OK 74653-5526
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
10/21/2022
Last updated
10/21/2022
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