Individual
CHARLES IVY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4620 S VANDALIA AVE, TULSA, OK 74135-4715
(918) 565-7151
Mailing address
4620 S VANDALIA AVE, TULSA, OK 74135-4715
(918) 565-7151
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
09/04/2020
Last updated
09/04/2020
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