Provider Demographics
NPI:1508408394
Name:GOWER, SHANDA LYNN (CNP)
Entity Type:Individual
Prefix:MRS
First Name:SHANDA
Middle Name:LYNN
Last Name:GOWER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 W LINDSEY ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-4101
Mailing Address - Country:US
Mailing Address - Phone:405-579-4673
Mailing Address - Fax:
Practice Address - Street 1:1807 W LINDSEY ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-4101
Practice Address - Country:US
Practice Address - Phone:405-579-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-13
Last Update Date:2019-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK81012363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily