Provider Demographics
NPI:1720430507
Name:POOR BUFFALO, SHANNA (APRN, CNP-FAMILY)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:
Last Name:POOR BUFFALO
Suffix:
Gender:F
Credentials:APRN, CNP-FAMILY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 BETTER NOW PLZ
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-2279
Mailing Address - Country:US
Mailing Address - Phone:580-310-9899
Mailing Address - Fax:580-310-9818
Practice Address - Street 1:709 BETTER NOW PLZ
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-2279
Practice Address - Country:US
Practice Address - Phone:580-310-9899
Practice Address - Fax:580-310-9818
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103544363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily