Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | R0077957 | OK |
NPI | 1003363250 |
---|---|
Provider Name | Harvey Shane Adams |
First Address | Oklahoma City, OK 73170-4842 |
Second Address | Oklahoma City, OK 73170-4842 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2016 |
Last Update Date | 04/10/2017 |