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1114279726
SHANE D. STACK
OKLAHOMA CITY, OK
NPI
1114279726
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
207L00000X Anesthesiology
(Licence: OK 123592)
Enumeration Date
2012-10-05
Last Update Date
2019-01-15
Business Address
MRS. SHANE D. STACK CRNA
920 STANTON L YOUNG BLVD # WP1140
OKLAHOMA CITY, OK 73104-5036
Phone number: 405-271-4351
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Mailing Address
MRS. SHANE D. STACK CRNA
PO BOX 26901, WP1140
OKLAHOMA CITY, OK 73126-0901
Phone number: 405-271-4351
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