Individual
SHANNON WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
12455 E 100TH ST N STE 300, OWASSO, OK 74055-4678
(918) 274-9700
(918) 274-1395
Mailing address
12455 E 100TH ST N STE 300, OWASSO, OK 74055-4678
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
75091
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
75091
STATE LICENSE
OK
Enumeration date
09/01/2017
Last updated
09/01/2017
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