Individual
DIANNE MARISE JEANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
201 E CHESTNUT AVE, PONCA CITY, OK 74601-4311
(580) 763-6017
Mailing address
1500 N 6TH ST, PONCA CITY, OK 74601-2827
(580) 763-6017
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
08/09/2017
Last updated
08/09/2017
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