Individual
MRS. STACEY MAXWELL BERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
101 E ROSS AVE, SAPULPA, OK 74066-6425
(918) 227-2016
Mailing address
101 E ROSS AVE, SAPULPA, OK 74066-6425
(918) 227-2016
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
L082124643
OK
Other
Enumeration date
08/21/2008
Last updated
08/21/2008
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