Individual
JENNIFER JANELLE LASITER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
17675 S MUSKOGEE AVE, TAHLEQUAH, OK 74464-5492
(918) 453-5000
Mailing address
17675 S MUSKOGEE AVE, TAHLEQUAH, OK 74464-5492
(918) 453-5000
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1134704489
CHEROKEE NATION
OK
Enumeration date
10/06/2022
Last updated
10/06/2022
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