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>> Case Manager/Care Coordinator >> Other Service Providers

Registrant NPI Number: 1396960423

Individual Registrant:
Gender: F
Not Sole Proprietor

Location and contact information for practice:
1500 N 6TH ST  PONCA CITY, OK 74601-2827 US
Tel: 580-762-7561  Fax: 580-762-2576

Contact information for business:
5404 80 RD  PONCA CITY, OK 74604-6156 US
Tel: 580-761-7344  Fax: --

Registration Information:
NPI: 1396960423
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y171M00000XOther Service Providers
Case Manager/Care Coordinator

Legacy codes, insurance codes and state license numbers:



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