Individual
MRS. PAIGE JUHREE THEISSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A,-C
Contact information
Practice address
116 E ROBERT S KERR BLVD, WYNNEWOOD, OK 73098-6621
(405) 238-4153
(405) 665-5108
Mailing address
2309 PORT RUSH DRIVE, MOORE, OK 73160
(405) 238-4153
(405) 665-5108
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1795
OK
Other
Enumeration date
02/18/2009
Last updated
02/18/2009
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