Individual
MARY JANELLE MURRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1715 N 5TH ST, PONCA CITY, OK 74601-2763
(580) 762-9292
Mailing address
1715 N 5TH ST, PONCA CITY, OK 74601-2763
(580) 762-9292
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
67414
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200810780A
—
OK
Enumeration date
07/10/2018
Last updated
11/09/2021
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