Individual
MRS. JESSICA DIANA LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4436 NW 50TH ST, OKLAHOMA CITY, OK 73112-2212
(405) 858-2700
Mailing address
16787 SE 27TH ST, CHOCTAW, OK 73020-6446
(405) 618-0079
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
11/06/2024
Last updated
11/06/2024
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