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Individual

KATRENNA DALE GOMEZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPN

Contact information

Practice address
12309 E 25TH PL, TULSA, OK 74129-5820
(918) 720-8204
(918) 771-3803
Mailing address
12309 E 25TH PL, TULSA, OK 74129-5820
(918) 720-8204
(918) 771-3803

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
57534
OK

Other

Enumeration date
05/24/2018
Last updated
05/24/2018
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