Individual
MISS JENNIFER FANNIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1215 NW 25 TH ST., OKC, OK 73106
(405) 525-2525
Mailing address
1215 NW 25TH ST, OKLAHOMA CITY, OK 73106-5629
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
B9334731
OK
Other
Enumeration date
06/18/2010
Last updated
06/18/2010
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