Individual
MISS PAIGE MARIE CORDOVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
13 HILLCREST DR, PONCA CITY, OK 74604-4808
(580) 761-5197
Mailing address
608 E FRESNO AVE, PONCA CITY, OK 74601-2819
(580) 716-8421
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L0067313
OK
Other
Enumeration date
11/01/2020
Last updated
11/01/2020
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