Individual
BREA DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
72548 S 322 WAY LOT 31, WAGONER, OK 74467-7050
(918) 816-9277
Mailing address
72548 S 322 WAY LOT 31, WAGONER, OK 74467-7050
(918) 816-9277
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
01/23/2023
Last updated
01/23/2023
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