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Shadava Wallace
NPI 1215656517 · on the registry since 2022 · sole proprietor
Practice
- Address
- 136 Meadowview St
Hugo, OK 74743 - Phone
- (580) 424-4239
Registry record
- Primary taxonomy
- 101Y00000X
101Y00000X
- Licence states on file
- OK
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2022-08-22
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Oklahoma