Individual
LISHA RYANNE PORCH-PETITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNS
Contact information
Practice address
2000 S WHEELING AVE, STE 200, TULSA, OK 74104-5649
(918) 748-7854
(918) 293-3116
Mailing address
1515 N HARVARD AVE, STE E, TULSA, OK 74115-4957
(918) 832-6049
Taxonomy
Speciality
Code
Description
License number
State
364S00000X
Clinical Nurse Specialist
Primary
0058269
OK
Other
Enumeration date
06/29/2009
Last updated
07/31/2009
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