Individual
TAMALYA LYN WILLOUGHBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2307 GORDON COOPER DR, SHAWNEE, OK 74801-9007
(405) 878-4693
Mailing address
544 N CENTER AVE, SHAWNEE, OK 74801-7215
(405) 878-4693
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
0050130
OK
Other
Enumeration date
11/02/2012
Last updated
11/02/2012
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