Individual
SHAUNI RENEE VICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1721 E OMAHA ST, BROKEN ARROW, OK 74012-0361
(918) 699-9184
Mailing address
1721 E OMAHA ST, BROKEN ARROW, OK 74012-0361
(918) 699-9184
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
12/22/2025
Last updated
12/22/2025
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