Individual
FAYETTE LOUISE WILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
109 S HARRILL AVE, WAGONER, OK 74467-5317
(918) 485-0242
(918) 485-0204
Mailing address
109 S HARRILL AVE, WAGONER, OK 74467-5317
(918) 485-0242
(918) 485-0204
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
1437830882
OK
Other
Enumeration date
07/28/2023
Last updated
08/31/2023
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