Individual
ALICIA MARIE JOHANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6216 S LEWIS AVE, TULSA, OK 74136-1044
(918) 416-4483
Mailing address
4316 W 6TH ST, SKIATOOK, OK 74070-6213
(918) 671-1597
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
05/24/2023
Last updated
05/24/2023
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