Organization
LANE FAMILY CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAMI LYNN FOWLER CNP (OWNER)
(580) 212-0303
Entity
Organization
Contact information
Practice address
207 WEST 10TH STREET, WRIGHT CITY, OK 74766
(580) 981-2104
(580) 981-2105
Mailing address
PO BOX 650, WRIGHT CITY, OK 74766-0650
(580) 981-2104
(580) 981-2105
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
08/04/2020
Last updated
08/04/2020
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