Doctor Name: | MRS. BONNIE LOU STITES |
NPI Number: | 1124051222 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ARDMS |
License Number: | 107390 |
Business Practice Address: | Rr 2 Box 180b Sallisaw, OK - 749558901 |
Business Phone Number: | 9187740004 |
Business Fax Number: | |
Mailing Address: | Rr 2 Box 180b, SALLISAW |
State: | OK |
Postal Code: | 749558901 |
Phone Number: | 9187740004 |
Fax Number: | |
NPI Enumeration Date: | 07/09/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2471S1302X |
License Number: | 107390 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
Taxonomy Classification: | Radiologic Technologist |
Taxonomy Specialization: | Sonography |
Taxonomy Definition: |