Individual
BETHANY LADAWN HANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, IBCLC
Contact information
Practice address
300 ROCKEFELLER DR, MUSKOGEE, OK 74401-5075
(918) 684-2157
Mailing address
PO BOX 3483, MUSKOGEE, OK 74402-3483
(918) 684-2157
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
73597
OK
163WL0100X
Lactation Consultant (Registered Nurse)
11124970
OK
Other
Enumeration date
04/18/2012
Last updated
04/18/2012
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