Individual
MACEY SHANAE BLAKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3000 S 9TH AVE TRLR 91, PURCELL, OK 73080-8441
(580) 380-5652
Mailing address
3000 S 9TH AVE TRLR 91, PURCELL, OK 73080-8441
(580) 380-5652
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
08/18/2021
Last updated
08/18/2021
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