Individual
LISA A MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1219 W DUPONT ST, CLAREMORE, OK 74017-5318
(918) 341-1424
Mailing address
31312 E 683 RD, WAGONER, OK 74467-6304
(918) 813-1005
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
10/21/2021
Last updated
10/21/2021
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