Individual
MRS. JACQUELINE CHANTHAY WILLIAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1323 E ASH ST, ALTUS, OK 73521-2908
(580) 318-9451
Mailing address
1323 E ASH ST, ALTUS, OK 73521-2908
(580) 318-9451
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
44674
OK
Other
Enumeration date
03/22/2019
Last updated
03/22/2019
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