Provider Demographics
NPI:1588400105
Name:POPE, SHAWNA MICHELLE
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:MICHELLE
Last Name:POPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2417 NW 193RD ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-3541
Mailing Address - Country:US
Mailing Address - Phone:870-497-0951
Mailing Address - Fax:
Practice Address - Street 1:2417 NW 193RD ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-3541
Practice Address - Country:US
Practice Address - Phone:870-497-0951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist