Individual
TRACY DEJESUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1616 BROWN OAKS DR, OKLAHOMA CITY, OK 73127-3132
(405) 515-3612
Mailing address
1616 BROWN OAKS DR, OKLAHOMA CITY, OK 73127-3132
Taxonomy
Speciality
Code
Description
License number
State
163WL0100X
Lactation Consultant (Registered Nurse)
Primary
100792
OK
Other
Enumeration date
01/08/2015
Last updated
01/08/2015
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