Healthcare Provider Details

I. General information

NPI: 1235435058
Provider Name (Legal Business Name): MRS. GLENDA SUE DONOVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2011
Last Update Date: 01/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 NW 7TH ST
STIGLER OK
74462-2794
US

IV. Provider business mailing address

803 NW 7TH ST P.O. BOX 447
STIGLER OK
74462-2794
US

V. Phone/Fax

Practice location:
  • Phone: 918-967-8558
  • Fax:
Mailing address:
  • Phone: 918-967-8558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: