Individual
DUSTY ROLLICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PRSS
Contact information
Practice address
1323 W KEETOOWAH ST, TAHLEQUAH, OK 74464-3462
(918) 316-0573
Mailing address
1323 W KEETOOWAH ST, TAHLEQUAH, OK 74464-3462
(918) 931-3890
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
OK
Other
Enumeration date
07/15/2022
Last updated
07/15/2022
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