Individual
CRAE PFANNENSTIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
19819 E 47TH ST S, BROKEN ARROW, OK 74014-1376
(918) 706-4425
Mailing address
19819 E 47TH ST S, BROKEN ARROW, OK 74014-1376
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
08/15/2023
Last updated
08/15/2023
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