Shelby Dane Menie, LPN
Licensed Practical Nurse in Gore, OK. Individual provider (NPI-1).
NPI number1013787134
StatusActive
Last updated in NPPESJan 9, 2024
Details
- NPI
- 1013787134
- Entity type
- Individual (NPI-1)
- Name
- Shelby Dane Menie
- Credential
- LPN
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jan 9, 2024
- Certification date
- Jan 7, 2024
- Last updated
- Jan 9, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 164W00000X | Licensed Practical Nurse | l0065513 | OK | Yes |
Practice location
300 W 5th St Lot 19Gore, OK 74435-5377
Phone 918-348-4384
Mailing address
711 S Muskogee AveTahlequah, OK 74464-4717
Phone 918-348-4384
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