Individual
TAMMY DIAN BURKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
110 N 4TH ST, PONCA CITY, OK 74601-4527
(580) 749-5056
Mailing address
110 N 4TH ST, PONCA CITY, OK 74601-4527
(580) 749-5056
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
0096631
OK
Other
Enumeration date
12/20/2019
Last updated
12/20/2019
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