Individual
MRS. JAN LANELL KUKUK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
800 FIR ST, PERRY, OK 73077-4239
(580) 336-4474
(580) 336-0108
Mailing address
800 FIR ST, PERRY, OK 73077-4239
(580) 336-4474
(580) 336-0108
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L0028360
OK
Other
Enumeration date
09/04/2012
Last updated
09/04/2012
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