Individual
LYSONIA MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
111 E 12TH ST, ADA, OK 74820-6501
(580) 436-2690
Mailing address
111 E 12TH ST, ADA, OK 74820-6501
(580) 436-2690
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
85544
OK
Other
Enumeration date
02/01/2017
Last updated
02/01/2017
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