Individual
JACIE MARCUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1336 N HARRISON AVE, SHAWNEE, OK 74801-5206
(405) 424-7711
Mailing address
1619 N 1ST ST, HARRAH, OK 73045-9711
(405) 996-7534
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/07/2022
Last updated
01/07/2022
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