Individual
BRENDA STACY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
507 DRWEY, POTESU, OK 74953
(918) 649-0172
Mailing address
507 DRWEY, POTESU, OK 74953
(918) 649-0172
Taxonomy
Speciality
Code
Description
License number
State
405300000X
Prevention Professional
Primary
261QM0801X
OK
Other
Enumeration date
02/06/2017
Last updated
02/06/2017
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