Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | ||
Y | 1041C0700X | Clinical Social Worker | 3868-P | OK |
NPI | 1003053620 |
---|---|
Provider Name | Nancy S Cheely |
First Address | Panama, OK 74951-0127 |
Second Address | Muskogee, OK 74403-8876 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2009 |
Last Update Date | 14/10/2009 |