Individual
NICHOLAS RYAN GROOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
6333 E SKELLY DR, TULSA, OK 74135-6106
(918) 664-4224
Mailing address
6333 E SKELLY DR, TULSA, OK 74135-6106
(918) 664-4224
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L0063960
OK
Other
Enumeration date
04/11/2022
Last updated
04/11/2022
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