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Individual
MRS. LEISA GAYLE CARR
Active
Individual
MRS. LEISA GAYLE CARR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
172A00000X
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20091200A
—
OK
Enumeration date
03/22/2007
Last updated
07/08/2007
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