Organization
SHANA NETHERLAIN DAVIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANA NETHERLAIN DAVIS MPA (BHRS)
(918) 864-1013
Entity
Organization
Contact information
Practice address
1624 CLAYTON DR, TAHLEQUAH, OK 74464-8004
(918) 864-1013
Mailing address
1624 CLAYTON DR, TAHLEQUAH, OK 74464-8004
(918) 864-1013
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
03/29/2012
Last updated
03/29/2012
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