Provider Demographics
NPI:1780394551
Name:RADER, DIEDREA SHEA
Entity type:Individual
Prefix:
First Name:DIEDREA
Middle Name:SHEA
Last Name:RADER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIEDREA
Other - Middle Name:SHEA
Other - Last Name:BROWNLOW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:231 E GRAHAM AVE
Mailing Address - Street 2:
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74361-2436
Mailing Address - Country:US
Mailing Address - Phone:918-825-1405
Mailing Address - Fax:
Practice Address - Street 1:231 E GRAHAM AVE
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-2436
Practice Address - Country:US
Practice Address - Phone:918-825-1405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist