Provider Demographics
NPI:1639436348
Name:MANSKER, SHELLY DAWN (FNP-C)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:DAWN
Last Name:MANSKER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:DAWN
Other - Last Name:LOFTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31870 HWY 51
Mailing Address - Street 2:
Mailing Address - City:COWETA
Mailing Address - State:OK
Mailing Address - Zip Code:74429-4429
Mailing Address - Country:US
Mailing Address - Phone:918-279-3200
Mailing Address - Fax:918-279-1118
Practice Address - Street 1:31870 HWY 51
Practice Address - Street 2:
Practice Address - City:COWETA
Practice Address - State:OK
Practice Address - Zip Code:74429
Practice Address - Country:US
Practice Address - Phone:918-279-3200
Practice Address - Fax:918-279-1118
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR69284363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner