Individual
TRACIE WHITESHIRT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
403 N MARSHALL AVE, WATONGA, OK 73772
(405) 464-0603
Mailing address
403 N MARSHALL AVE, WATONGA, OK 73772
(405) 464-0603
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
05/25/2022
Last updated
05/25/2022
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