Individual
CLINT HISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
101 S MOORE AVE, CLAREMORE, OK 74017-5091
(918) 342-6495
Mailing address
101 S MOORE AVE, CLAREMORE, OK 74017-5091
(918) 342-6495
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
Primary
109411
OK
Other
Enumeration date
09/23/2019
Last updated
09/23/2019
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