Individual
LISTA MARIE DALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1500 E DOWNING ST STE 214, TAHLEQUAH, OK 74464-3379
(918) 413-0202
(918) 431-0203
Mailing address
PO BOX 751, HULBERT, OK 74441-0751
(187) 723-3990
(918) 772-3638
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
99753
OK
Other
Enumeration date
10/16/2019
Last updated
02/17/2022
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